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 RichstoneFrancis Schanne, Douglas S. Scherr, Stefan Siemer, Michael Stöckle, Eric M. Wallen, Alon Z. Weizer, Peter Wiklund, Timothy Wilson, Michael Woods, Khurshid A. Guru

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1075-1080
Number of pages6
JournalBJU International
Volume111
Issue number7
DOIs
Publication statusPublished - 2013 Jun 1

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Cystectomy
Robotics
Lymph Node Excision
Urinary Bladder Neoplasms
Odds Ratio
Surgeons
Confidence Intervals
Minimally Invasive Surgical Procedures
Blood Vessels
Dissection
Logistic Models
Regression Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Urology

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Marshall, Susan J. ; Hayn, Matthew H. ; Stegemann, Andrew P. ; Agarwal, Piyush K. ; Badani, Ketan K. ; Balbay, M. Derya ; Dasgupta, Prokar ; Hemal, Ashok K. ; Hollenbeck, Brent K. ; Kibel, Adam S. ; Menon, Mani ; Mottrie, Alex ; Nepple, Kenneth ; Pattaras, John G. ; Peabody, James O. ; Poulakis, Vassilis ; Pruthi, Raj S. ; Palou Redorta, Joan ; Rha, Koon Ho ; Richstone, Lee ; Schanne, Francis ; Scherr, Douglas S. ; Siemer, Stefan ; Stöckle, Michael ; Wallen, Eric M. ; Weizer, Alon Z. ; Wiklund, Peter ; Wilson, Timothy ; Woods, Michael ; Guru, Khurshid A. / Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy : Results from the International Robotic Cystectomy Consortium (IRCC). In: BJU International. 2013 ; Vol. 111, No. 7. pp. 1075-1080.
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title = "Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy: Results from the International Robotic Cystectomy Consortium (IRCC)",
abstract = "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.",
author = "Marshall, {Susan J.} and Hayn, {Matthew H.} and Stegemann, {Andrew P.} and Agarwal, {Piyush K.} and Badani, {Ketan K.} and Balbay, {M. Derya} and Prokar Dasgupta and Hemal, {Ashok K.} and Hollenbeck, {Brent K.} and Kibel, {Adam S.} and Mani Menon and Alex Mottrie and Kenneth Nepple and Pattaras, {John G.} and Peabody, {James O.} and Vassilis Poulakis and Pruthi, {Raj S.} and {Palou Redorta}, Joan and Rha, {Koon Ho} and Lee Richstone and Francis Schanne and Scherr, {Douglas S.} and Stefan Siemer and Michael St{\"o}ckle and Wallen, {Eric M.} and Weizer, {Alon Z.} and Peter Wiklund and Timothy Wilson and Michael Woods and Guru, {Khurshid A.}",
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Marshall, SJ, Hayn, MH, Stegemann, AP, Agarwal, PK, Badani, KK, Balbay, MD, Dasgupta, P, Hemal, AK, Hollenbeck, BK, Kibel, AS, Menon, M, Mottrie, A, Nepple, K, Pattaras, JG, Peabody, JO, Poulakis, V, Pruthi, RS, Palou Redorta, J, Rha, KH, Richstone, L, Schanne, F, Scherr, DS, Siemer, S, Stöckle, M, Wallen, EM, Weizer, AZ, Wiklund, P, Wilson, T, Woods, M & Guru, KA 2013, 'Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy: Results from the International Robotic Cystectomy Consortium (IRCC)', BJU International, vol. 111, no. 7, pp. 1075-1080. https://doi.org/10.1111/j.1464-410X.2012.11583.x

Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy : Results from the International Robotic Cystectomy Consortium (IRCC). / Marshall, Susan J.; Hayn, Matthew H.; Stegemann, Andrew P.; Agarwal, Piyush K.; Badani, Ketan K.; Balbay, M. Derya; Dasgupta, Prokar; Hemal, Ashok K.; Hollenbeck, Brent K.; Kibel, Adam S.; Menon, Mani; Mottrie, Alex; Nepple, Kenneth; Pattaras, John G.; Peabody, James O.; Poulakis, Vassilis; Pruthi, Raj S.; Palou Redorta, Joan; Rha, Koon Ho; Richstone, Lee; Schanne, Francis; Scherr, Douglas S.; Siemer, Stefan; Stöckle, Michael; Wallen, Eric M.; Weizer, Alon Z.; Wiklund, Peter; Wilson, Timothy; Woods, Michael; Guru, Khurshid A.

In: BJU International, Vol. 111, No. 7, 01.06.2013, p. 1075-1080.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy

T2 - Results from the International Robotic Cystectomy Consortium (IRCC)

AU - Marshall, Susan J.

AU - Hayn, Matthew H.

AU - Stegemann, Andrew P.

AU - Agarwal, Piyush K.

AU - Badani, Ketan K.

AU - Balbay, M. Derya

AU - Dasgupta, Prokar

AU - Hemal, Ashok K.

AU - Hollenbeck, Brent K.

AU - Kibel, Adam S.

AU - Menon, Mani

AU - Mottrie, Alex

AU - Nepple, Kenneth

AU - Pattaras, John G.

AU - Peabody, James O.

AU - Poulakis, Vassilis

AU - Pruthi, Raj S.

AU - Palou Redorta, Joan

AU - Rha, Koon Ho

AU - Richstone, Lee

AU - Schanne, Francis

AU - Scherr, Douglas S.

AU - Siemer, Stefan

AU - Stöckle, Michael

AU - Wallen, Eric M.

AU - Weizer, Alon Z.

AU - Wiklund, Peter

AU - Wilson, Timothy

AU - Woods, Michael

AU - Guru, Khurshid A.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - 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.

AB - 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.

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