Lymphadenectomy at the time of robot‐assisted radical cystectomy: results from the International Robotic Cystectomy Consortium

Abstract

What’s known on the subject? and What does the study add? It is known that the lymph node yield in open cystectomy is variable and dependent, in some part, upon surgeon experience. This study, the largest of its kind reporting on outcomes associated with robot‐assisted radical cystectomy, demonstrates that lymph node yields in experienced hands at the time of robot‐assisted radical cystectomy is comparable to that seen in open series. OBJECTIVE To evaluate the incidence of, and predictors for, lymphadenectomy in patients undergoing robot‐assisted radical cystectomy (RARC) for bladder cancer. PATIENTS AND 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]. CONCLUSION 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.

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

“…Exceptions included prospective studies [8,22,28,35,36,43,52,59,64,66,81,87] and some multi-institutional retrospective collaboration studies [16,23,25,30,45,48,54,61,68]. Only two of the comparative studies were randomized [74,83] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”

“…Patient characteristics and surgical aspects influencing lymph node yields with robotassisted radical cystectomy Table 2 summarizes the studies assessing the effects of patient characteristics and particular surgical aspects on lymph node yields in RARC series. Cumulative analysis from the International Robotic Cystectomy Consortium (IRCC) with respect to lymphadenectomy in 437 patients found a median of 17 lymph nodes removed, with a 20% node-positivity rate [23].…”

Robotic radical cystectomy for the management of bladder cancer: Analysis of operative and pathological outcomes of eighteen patient

“…As indicated in various publications, PET scans provide better visualization of anatomic sites, and facilitates especially removal of presacral (in case of need paracaval, paraaortic) lymph nodes. [21] In a cadaver study, 10-53 (median 8) pelvic lymph nodes were detected in patients who had previously undergone extended PLND. The authors indicated that upper level of dissection was more important than the number of lymph nodes removed.…”

Robotic-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Urinary Diversion (Studer Pouch or Ileal Conduit) for Bladder Cancer

“…Mean lymph node yield was 41.8 (18-67) in another series of 15 consecutive patients who underwent robotic radical cystectomy for bladder cancer (Lavery et al, 2010). Recently, International Robotic Cystectomy Consortium (IRCC) evaluated 527 patients who underwent robotic cystectomy for bladder cancer and mean lymph node yield was 17.8 (range 0-68) (Hellenthal et al, 2011). Mean lymph node yield was 21.3 (range, 8-38) and 24.8.9.2 in our initial series of 12 (Akbulut et al, 2011) and 27 cases (unpublihsed data), respectively.…”