TY - JOUR
T1 - Lymphadenectomy at the time of robot-assisted radical cystectomy
T2 - Results from the International Robotic Cystectomy Consortium
AU - Hellenthal, Nicholas J.
AU - Hussain, Abid
AU - Andrews, Paul E.
AU - Carpentier, Paul
AU - Castle, Erik
AU - Dasgupta, Prokar
AU - Kaouk, Jihad
AU - Khan, Shamim
AU - Kibel, Adam
AU - Kim, Hyung
AU - Manoharan, Murugesan
AU - Menon, Mani
AU - Mottrie, Alex
AU - Ornstein, David
AU - Palou, Joan
AU - Peabody, James
AU - Pruthi, Raj
AU - Richstone, Lee
AU - Schanne, Francis
AU - Stricker, Hans
AU - Thomas, Raju
AU - Wiklund, Peter
AU - Wilding, Greg
AU - Guru, Khurshid A.
PY - 2011/2
Y1 - 2011/2
N2 - What's known on the subject? and What does the study add? It is known that the lymph node yield in open cystectomy is variable and dependent, in some part, upon surgeon experience. This study, the largest of its kind reporting on outcomes associated with robot-assisted radical cystectomy, demonstrates that lymph node yields in experienced hands at the time of robot-assisted radical cystectomy is comparable to that seen in open series. OBJECTIVE To evaluate the incidence of, and predictors for, lymphadenectomy in patients undergoing robot-assisted radical cystectomy (RARC) for bladder cancer. PATIENTS AND METHODS Utilizing the International Robotic Cystectomy Consortium (IRCC) database, 527 patients were identified who underwent RARC at 15 institutions from 2003 to 2009. After stratification by age group, sex, pathological T stage, nodal status, sequential case number, institutional volume and surgeon volume, logistic regression was used to correlate variables to the likelihood of undergoing lymphadenectomy (defined as â ¥10 nodes removed). RESULTS Of the 527 patients, 437 (82.9%) underwent lymphadenectomy. A mean of 17.8 (range 0-68) lymph nodes were examined. Tumour stage, sequential case number, institution volume and surgeon volume were significantly associated with the likelihood of undergoing lymphadenectomy. Surgeon volume was most significantly associated with lymphadenectomy on multivariate analysis. High-volume surgeons (>20 cases) were almost three times more likely to perform lymphadenectomy than lower-volume surgeons, all other variables being constant [odds ratio (OR) = 2.37; 95% confidence interval (CI) = 1.39-4.05; P= 0.002]. CONCLUSION The rates of lymphadenectomy at RARC for advanced bladder cancer are similar to those of open cystectomy series using a large, multi-institutional cohort. There does, however, appear to be a learning curve associated with the performance of lymphadenectomy at RARC.
AB - What's known on the subject? and What does the study add? It is known that the lymph node yield in open cystectomy is variable and dependent, in some part, upon surgeon experience. This study, the largest of its kind reporting on outcomes associated with robot-assisted radical cystectomy, demonstrates that lymph node yields in experienced hands at the time of robot-assisted radical cystectomy is comparable to that seen in open series. OBJECTIVE To evaluate the incidence of, and predictors for, lymphadenectomy in patients undergoing robot-assisted radical cystectomy (RARC) for bladder cancer. PATIENTS AND METHODS Utilizing the International Robotic Cystectomy Consortium (IRCC) database, 527 patients were identified who underwent RARC at 15 institutions from 2003 to 2009. After stratification by age group, sex, pathological T stage, nodal status, sequential case number, institutional volume and surgeon volume, logistic regression was used to correlate variables to the likelihood of undergoing lymphadenectomy (defined as â ¥10 nodes removed). RESULTS Of the 527 patients, 437 (82.9%) underwent lymphadenectomy. A mean of 17.8 (range 0-68) lymph nodes were examined. Tumour stage, sequential case number, institution volume and surgeon volume were significantly associated with the likelihood of undergoing lymphadenectomy. Surgeon volume was most significantly associated with lymphadenectomy on multivariate analysis. High-volume surgeons (>20 cases) were almost three times more likely to perform lymphadenectomy than lower-volume surgeons, all other variables being constant [odds ratio (OR) = 2.37; 95% confidence interval (CI) = 1.39-4.05; P= 0.002]. CONCLUSION The rates of lymphadenectomy at RARC for advanced bladder cancer are similar to those of open cystectomy series using a large, multi-institutional cohort. There does, however, appear to be a learning curve associated with the performance of lymphadenectomy at RARC.
KW - bladder cancer
KW - cystectomy
KW - lymphadenectomy
KW - robotic
UR - http://www.scopus.com/inward/record.url?scp=77956506782&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77956506782&partnerID=8YFLogxK
U2 - 10.1111/j.1464-410X.2010.09473.x
DO - 10.1111/j.1464-410X.2010.09473.x
M3 - Article
C2 - 20575975
AN - SCOPUS:77956506782
SN - 1464-4096
VL - 107
SP - 642
EP - 646
JO - BJU international
JF - BJU international
IS - 4
ER -