title: Surgical margin status after robot assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
abstract: OBJECTIVE
  Positive surgical margins at radical cystectomy confer a poor prognosis. We evaluated the incidence and predictors of positive surgical margins in patients who underwent robot assisted radical cystectomy for bladder cancer.
  
  
  METHODS
  Using the International Robotic Cystectomy Consortium database we identified 513 patients who underwent robot assisted radical cystectomy, as done by a total of 22 surgeons at 15 institutions from 2003 to 2009. After stratification by age group, gender, pathological T stage, nodal status, sequential case number and institutional volume logistic regression was used to correlate variables with the likelihood of a positive surgical margin.
  
  
  RESULTS
  Of the 513 patients 35 (6.8%) had a positive surgical margin. Increasing 10-year age group, lymph node positivity and higher pathological T stage were significantly associated with an increased likelihood of a positive margin (p = 0.010, <0.001 and p <0.001, respectively). Gender, sequential case number and institutional volume were not significantly associated with margin positivity. The rate of margin positive disease at cystectomy was 1.5% for pT2 or less, 8.8% for pT3 and 39% for pT4 disease.
  
  
  CONCLUSIONS
  Positive surgical margin rates at robot assisted radical cystectomy for advanced bladder cancer were similar to those in open cystectomy series in a large, multi-institutional, prospective cohort. Sequential case number, a surrogate for the learning curve and institutional volume were not significantly associated with positive margins at robot assisted radical cystectomy.
authors.affiliation: Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Hellenthal
authors.forename: Abid
authors.initials: A
authors.lastname: Hussain
authors.forename: Paul E
authors.initials: PE
authors.lastname: Andrews
authors.forename: Paul
authors.initials: P
authors.lastname: Carpentier
authors.forename: Erik
authors.initials: E
authors.lastname: Castle
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Shamim
authors.initials: S
authors.lastname: Khan
authors.forename: Adam
authors.initials: A
authors.lastname: Kibel
authors.forename: Hyung
authors.initials: H
authors.lastname: Kim
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Alex
authors.initials: A
authors.lastname: Mottrie
authors.forename: David
authors.initials: D
authors.lastname: Ornstein
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.forename: Raj
authors.initials: R
authors.lastname: Pruthi
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.forename: Francis
authors.initials: F
authors.lastname: Schanne
authors.forename: Hans
authors.initials: H
authors.lastname: Stricker
authors.forename: Raju
authors.initials: R
authors.lastname: Thomas
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
authors.forename: Greg
authors.initials: G
authors.lastname: Wilding
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012371:Robotics; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*