Departments of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
BJU Int. 2011 Feb;107(4):642-6. doi: 10.1111/j.1464-410X.2010.09473.x.
To evaluate the incidence of, and predictors for, lymphadenectomy in patients undergoing robot-assisted radical cystectomy (RARC) for bladder cancer.
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).
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].
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.
评估在因膀胱癌接受机器人辅助根治性膀胱切除术（RARC）的患者中进行淋巴结切除术的发生率和预测因素。
利用国际机器人膀胱切除术联合会（IRCC）数据库，确定了 2003 年至 2009 年间在 15 家机构接受 RARC 的 527 名患者。根据年龄组、性别、病理 T 分期、淋巴结状态、连续病例数、机构容量和外科医生容量分层后，使用逻辑回归将变量与进行淋巴结切除术的可能性（定义为切除≥10 个淋巴结）相关联。
在 527 名患者中，437 名（82.9%）进行了淋巴结切除术。平均检查了 17.8 个（范围 0-68）淋巴结。肿瘤分期、连续病例数、机构容量和外科医生容量与进行淋巴结切除术的可能性显著相关。在多变量分析中，外科医生容量与淋巴结切除术的相关性最大。在所有其他变量保持不变的情况下，高容量外科医生（>20 例）进行淋巴结切除术的可能性几乎是低容量外科医生的三倍[优势比（OR）=2.37；95%置信区间（CI）=1.39-4.05；P=0.002]。
在使用大型多机构队列的情况下，RARC 治疗晚期膀胱癌的淋巴结切除术率与开放膀胱切除术系列相似。然而，在 RARC 中进行淋巴结切除术似乎存在学习曲线。
