Lymphadenectomy at the time of robot‐assisted radical cystectomy: results from the International Robotic Cystectomy Consortium |
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| Authors: | Nicholas J. Hellenthal Abid Hussain Paul E. Andrews Paul Carpentier Erik Castle Prokar Dasgupta Jihad Kaouk Shamim Khan Adam Kibel Hyung Kim Murugesan Manoharan Mani Menon Alex Mottrie David Ornstein Joan Palou James Peabody Raj Pruthi Lee Richstone Francis Schanne Hans Stricker Raju Thomas Peter Wiklund Greg Wilding Khurshid A. Guru |
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| Affiliation: | 1. Departments of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA;2. Mayo Clinic, Scottsdale, AZ, USA;3. Onze‐Lieve‐Vrouw Ziekenhuis, Aalst, Belgium;4. Guy’s Hospital, London, UK;5. Cleveland Clinic Foundation, Cleveland, OH, USA;6. Washington University, St Louis, MO, USA;7. University of Miami, Miami, FL, USA;8. Henry Ford Health System, Detroit, MI, USA;9. 21st Century Oncology, Naples, FL, USA;10. Fundacio Puigvert, Barcelona, Spain;11. University of North Carolina, Chapel Hill, NC, USA;12. Arthur Smith Institute for Urology, Long Island, NY, USA;13. Urologic Surgical Associates of Delaware, Wilmington, DE, USA;14. Tulane University, New Orleans, LA, USA;15. Karoliniska University, Stockholm, Sweden |
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| Abstract: | 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 ≥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. |
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| Keywords: | bladder cancer cystectomy lymphadenectomy robotic |
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