Indication for and Extension of Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy: An Analysis of Five European Institutions

Suardi, Nazareno; Larcher, Alessandro; Haese, Alexander; Ficarra, Vincenzo; Govorov, Alexander; Buffi, Nicolò Maria; Walz, Jochen; Rocco, Bernardo; Borghesi, Marco; Steuber, Thomas; Pini, Giovannalberto; Briganti, Alberto; Mottrie, Alexandre; Guazzoni, G.; Montorsi, Francesco; Pushkar, Dmitry; Poel, Henk van der

doi:10.1016/j.eururo.2013.12.059

Cited by 55 publications

(39 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The percentage of low-risk men in our cohort receiving a PLND compares favorably with the 34.5% of low-risk men receiving a PLND in Suardi's study of 3058 men undergoing RARP at five European institutions from 2005 to 2012. 16 This rate of PLND carried out with RARP in the European series matches the rate of PLND carried out with ORP in our cohort, which trended down to~35% by 2013. Nevertheless, the increase in PLND in low-risk men undergoing RARP, while a decrease in PLND among low-risk men undergoing ORP, is a novel finding and cause for concern.…”

Section: Discussionmentioning

confidence: 76%

“…Overall, 34.5% of low-risk, 64.9% of intermediate-risk and 91.2% of high-risk patients received a PLND. 16 One unanswered question is how the rate of PLND is evolving over time, especially in more recent years, as RARP has become the predominant modality for RP. To address this, we evaluated PLND performance over time, stratified by PC risk group and surgical technique, within an equal access care setting.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Utilization and impact of surgical technique on the performance of pelvic lymph node dissection at radical prostatectomy: Results from the SEARCH database.

McGinley

Sun

Howard

et al. 2015

JCO

View full text Add to dashboard Cite

Objective: To evaluate performance of pelvic lymph node dissection during radical prostatectomy within an equal access care setting over a period of time, and stratified by prostate cancer risk group and surgical technique. Methods: We identified men in the Shared Equal Access Regional Cancer Hospital database who had open or robotic-assisted radical prostatectomy from 2006 to 2013. Univariable logistic regression was used to test the association between age, race, body mass index, total biopsy cores, number of positive biopsy cores, risk group, year, center, surgical volume and surgical technique on pelvic lymph node dissection use. Multivariable logistic analysis was used to examine surgical technique and pelvic lymph node dissection performance. Spearman's correlation examined temporal changes in pelvic lymph node dissection utilization stratified by risk group and surgical technique. Results: A total of 1425 men met inclusion criteria; 67% of them underwent pelvic lymph node dissection. On multivariable analysis, robotic-assisted radical prostatectomy was associated with an 92% decreased use of pelvic lymph node dissection in low-risk, 84% decreased in intermediate-risk and 91% decreased in high-risk men (all P < 0.001). In robotic-assisted radical prostatectomy, there was a trend for increased pelvic lymph node dissection utilization over time in high-risk men (Spearman; P = 0.077) reaching 85% in 2012-2013, which was accompanied by increased use in low-risk men (P = 0.016). For open radical prostatectomy, fewer pelvic lymph node dissections were carried out in low-risk men over time, decreasing to~35% (P = 0.047) in 2012-2013, whereas rates remained high for high-risk men throughout (~95%; P = 0.621). Conclusion: Regardless of risk group, pelvic lymph node dissection is carried out significantly less during robotic-assisted radical prostatectomy. For robotic-assisted radical prostatectomy, pelvic lymph node dissection utilization increased over time for high-risk men, but rates also increased for low-risk men. Further attention to the discrepancy between provided and guideline recommended pelvic lymph node dissection performance is required to improve prostate cancer care.

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Utilization and impact of surgical technique on the performance of pelvic lymph node dissection at radical prostatectomy: Results from the SEARCH database.

McGinley

Sun

Howard

et al. 2015

JCO

View full text Add to dashboard Cite

show abstract

“…Adherence to national and international guidelines is suboptimal throughout Europe [17,18,19]. This is particularly true when considering urological diseases.…”

Section: Variation In Practice and Consequences Of Non-adherence To Cpgmentioning

confidence: 99%

“…Ultimately, the lack of widespread adoption of guidelines has detrimental effects on patient outcomes and increases costs for healthcare systems [17,18,19,29,30]. …”

Section: Variation In Practice and Consequences Of Non-adherence To Cpgmentioning

confidence: 99%

“…Differences among how healthcare systems are paid for and administered [3], as well as differences in clinician and patient profiles, represent some of the reasons for the lack of uniformity in the adoption of guidelines and evidence-based recommendations [19,40]. The EAU Guidelines Office “IMAGINE” project (IMpact Assessment of Guidelines Implementation and Education) has been developed to effectively tackle the issues of non-adherence and implementation with the ultimate goal of ensuring all patients across Europe receive the best evidence-based standardised care [41,42].…”

Section: Reasons For Variation In Practice and Non-adherence To Guidementioning

confidence: 99%

See 1 more Smart Citation

Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines: Can We Do Better

Smith

MacLennan²,

Bjartell

et al. 2017

Biomed Hub

Self Cite

View full text Add to dashboard Cite

The European Association of Urology (EAU) annually updates 21 clinical practice guidelines in which summaries of the evidence base and best practice recommendations are made. The methodology applied to achieve this and integrate stakeholder opinion is continuously improving. However, there is evidence to suggest wide variation in clinical practice indicating that many patients receive suboptimal and heterogeneous care. Studies from certain countries suggest that 2 out of 5 patients do not receive care according to the current scientific evidence, and in 1 out of 4 cases the care provided is potentially harmful. Clearly, the harmonisation of care in alignment with evidence-based best practice recommendations is something to strive for. Development of robust methods to disseminate and implement guideline recommendations and measure their impact is an objective the EAU is committed to improving. An important strategy for achieving harmonisation in urological care across Europe is to ensure the availability of high-quality clinical practice guidelines and to actively promote their implementation by clinicians and healthcare providers.

show abstract

Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

Indication for and Extension of Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy: An Analysis of Five European Institutions

Cited by 55 publications

References 24 publications

Utilization and impact of surgical technique on the performance of pelvic lymph node dissection at radical prostatectomy: Results from the SEARCH database.

Utilization and impact of surgical technique on the performance of pelvic lymph node dissection at radical prostatectomy: Results from the SEARCH database.

Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines: Can We Do Better

Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion

Contact Info

Product

Resources

About