Lymphadenectomy at the time of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
OBJECTIVE
To evaluate the incidence of, and predictors for, lymphadenectomy in patients undergoing robot-assisted radical cystectomy (RARC) for bladder cancer.


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].


CONCLUSIONS
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.
Hellenthal
Nicholas J
NJ
Departments of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Hussain
Abid
A
Andrews
Paul E
PE
Carpentier
Paul
P
Castle
Erik
E
Dasgupta
Prokar
P
Kaouk
Jihad
J
Khan
Shamim
S
Kibel
Adam
A
Kim
Hyung
H
Manoharan
Murugesan
M
Menon
Mani
M
Mottrie
Alex
A
Ornstein
David
D
Palou
Joan
J
Peabody
James
J
Pruthi
Raj
R
Richstone
Lee
L
Schanne
Francis
F
Stricker
Hans
H
Thomas
Raju
R
Wiklund
Peter
P
Wilding
Greg
G
Guru
Khurshid A
KA
D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods* / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*