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Impact of surgeon and volume on extended lymphadenectomy at the time of robot‐assisted radical cystectomy: results from the International Robotic Cystectomy Consortium (IRCC)
Journal article   Open access   Peer reviewed

Impact of surgeon and volume on extended lymphadenectomy at the time of robot‐assisted radical cystectomy: results from the International Robotic Cystectomy Consortium (IRCC)

Susan J Marshall, Matthew H Hayn, Andrew P Stegemann, Piyush K Agarwal, Ketan K Badani, M. Derya Balbay, Prokar Dasgupta, Ashok K Hemal, Brent K Hollenbeck, Adam S Kibel, …
BJU international, Vol.111(7), pp.1075-1080
06/2013
DOI: 10.1111/j.1464-410X.2012.11583.x
PMID: 23442001
url
https://doi.org/10.1111/j.1464-410X.2012.11583.xView
Published (Version of record) Open Access

Abstract

What's known on the subject? and What does the study add? Lymph node dissection and it's extend during robot‐assisted radical cystectomy varies based on surgeon related factors. This study reports outcomes of robot‐assisted extended lymphadenectomy based on surgeon experience in both academic and private practice settings. Objective To evaluate the incidence of, and predictors for, extended lymph node dissection (LND) in patients undergoing robot‐assisted radical cystectomy (RARC) for bladder cancer, as extendedLND is critical for the treatment of bladder cancer but the role of minimally invasive surgery for extended LND has not been well‐defined in a multi‐institutional setting. Patients and Methods Used the International Robotic Cystectomy Consortium (IRCC) database. In all, 765 patients who underwent RARC at 17 institutions from 2003 to 2010 were evaluated for receipt of extended LND. Patients were stratified by age, sex, clinical stage, institutional volume, sequential case number, and surgeon volume. Logistic regression analyses were used to correlate variables to the likelihood of undergoing extended LND. Results In all, 445 (58%) patients underwent extended LND. Among all patients, a median (range) of 18 (0–74) LNs were examined. High‐volume institutions (≥100 cases) had a higher mean LN yield (23 vs 15, P < 0.001). On univariable analysis, surgeon volume, institutional volume, and sequential case number were associated with likelihood of undergoing extended LND. On multivariable analysis, surgeon volume [odds ratio (OR) 3.46, 95% confidence interval (CI) 2.37–5.06, P < 0.001] and institution volume [OR 2.65, 95% CI 1.47–4.78, P = 0.001) were associated with undergoing extended LND. Conclusions Robot‐assisted LND can achieve similar LN yields to those of open LND after RC. High‐volume surgeons are more likely to perform extended LND, reflecting a correlation between their growing experience and increased comfort with advanced vascular dissection.
 cystectomy robotics bladder cancer lymphadenectomy

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