Variations in surgeon volume and use of pelvic lymph node dissection with open and minimally invasive radical prostatectomy.
OBJECTIVE
Although pelvic lymph node dissection (PLND) during radical prostatectomy (RP) improves staging, controversy remains concerning its indications and benefits on cancer control. We examined the factors associated with PLND use among men undergoing open RP (ORP) and minimally invasive RP (MIRP).


METHODS
Using a 5% national sample of Medicare beneficiaries from 2003 to 2005, we identified 2702 men who had undergone RP. Multivariate logistic regression analysis was used to assess whether the surgical approach, surgeon volume, patient demographics, comorbidity, and geographic region were associated with the likelihood of performing PLND.


RESULTS
Overall, 68% of men underwent PLND, although the rates varied by surgical approach (17% vs 83% for MIRP vs ORP, respectively, P <.001). In adjusted analyses, men undergoing MIRP vs ORP (odds ratio [OR] 0.02, 95% confidence interval [CI], 0.02-0.03), men > or = 75 vs 65-69 years old (OR 0.23, 95% CI 0.17-0.31), and men with multiple vs no comorbidities (OR 0.48, 95% CI 0.35-0.66 for Charlson score > or = 3 vs 0) were less likely to undergo PLND. High-volume minimally invasive surgeons were more likely to perform PLND (OR 1.19, 95% CI 1.14-1.25). Finally, men in the Western vs Southern United States (OR 1.61, 95% CI 1.19-2.17) were more likely to undergo PLND.


CONCLUSIONS
Men undergoing MIRP vs ORP were less likely to undergo PLND, although rates of the procedure increased with surgical volume. Additional studies are needed to determine the indications and benefits of this procedure for men with prostate cancer.
Prasad
Sandip M
SM
Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02478, USA.
Keating
Nancy L
NL
Wang
Qin
Q
Pashos
Chris L
CL
Lipsitz
Stuart
S
Richie
Jerome P
JP
Hu
Jim C
JC
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D016017:Odds Ratio; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery* / Q000628:therapy; D012044:Regression Analysis; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods; D014572:Urology / Q000379:methods*