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: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Lymph node dissection and it's extend during robot-assisted radical cystectomy varies based on surgeon related factors. This study reports outcomes of robot-assisted extended lymphadenectomy based on surgeon experience in both academic and private practice settings.
  
  
  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 extended LND 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.
  
  
  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.
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
authors: Susan J
authors: SJ
authors: Marshall
authors: Matthew H
authors: MH
authors: Hayn
authors: Andrew P
authors: AP
authors: Stegemann
authors: Piyush K
authors: PK
authors: Agarwal
authors: Ketan K
authors: KK
authors: Badani
authors: M Derya
authors: MD
authors: Balbay
authors: Prokar
authors: P
authors: Dasgupta
authors: Ashok K
authors: AK
authors: Hemal
authors: Brent K
authors: BK
authors: Hollenbeck
authors: Adam S
authors: AS
authors: Kibel
authors: Mani
authors: M
authors: Menon
authors: Alex
authors: A
authors: Mottrie
authors: Kenneth
authors: K
authors: Nepple
authors: John G
authors: JG
authors: Pattaras
authors: James O
authors: JO
authors: Peabody
authors: Vassilis
authors: V
authors: Poulakis
authors: Raj S
authors: RS
authors: Pruthi
authors: Joan
authors: J
authors: Palou Redorta
authors: Koon-Ho
authors: KH
authors: Rha
authors: Lee
authors: L
authors: Richstone
authors: Francis
authors: F
authors: Schanne
authors: Douglas S
authors: DS
authors: Scherr
authors: Stefan
authors: S
authors: Siemer
authors: Michael
authors: M
authors: Stöckle
authors: Eric M
authors: EM
authors: Wallen
authors: Alon Z
authors: AZ
authors: Weizer
authors: Peter
authors: P
authors: Wiklund
authors: Timothy
authors: T
authors: Wilson
authors: Michael
authors: M
authors: Woods
authors: Khurshid A
authors: KA
authors: Guru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*