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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)

 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  ;  Mani Menon  ;  Alex Mottrie  ;  Kenneth Nepple  ;  John G. Pattaras  ;  James O. Peabody  ;  Vassilis Poulakis  ;  Raj S. Pruthi  ;  Joan Palou Redorta  ;  Koon-Ho Rha  ;  Lee Richstone  ;  Francis Schanne  ;  Douglas S. Scherr  ;  Stefan Siemer  ;  Michael Stöckle  ;  Eric M. Wallen  ;  Alon Z. Weizer  ;  Peter Wiklund  ;  Timothy Wilson  ;  Michael Woods  ;  Khurshid A. Guru 
 BJU INTERNATIONAL, Vol.111(7) : 1075-1080, 2013 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Cystectomy/methods* ; Cystectomy/statistics & numerical data ; Female ; Hospitals, High-Volume/statistics & numerical data ; Hospitals, Low-Volume/statistics & numerical data ; Humans ; Logistic Models ; Lymph Node Excision/methods* ; Lymph Node Excision/statistics & numerical data* ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Male ; Middle Aged ; Physicians/statistics & numerical data* ; Practice Guidelines as Topic ; Prognosis ; Retrospective Studies ; Robotics* ; Treatment Outcome ; Urinary Bladder Neoplasms/surgery*
Lymphadenectomy ; bladder cancer ; cystectomy ; robotics
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 extended LND 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.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
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