title: Lymphadenectomy at the time of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
abstract: 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.
authors.affiliation: Departments of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, 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* / 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*