Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
BJU Int. 2013 Jun;111(7):1075-80. doi: 10.1111/j.1464-410X.2012.11583.x. Epub 2013 Feb 26.
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.
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.
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.
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.
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.
目的：评估在机器人辅助根治性膀胱切除术（RARC）治疗膀胱癌患者中进行扩大淋巴结清扫术（LND）的发生率和预测因素，因为扩大 LND 对膀胱癌的治疗至关重要，但在多机构环境中，微创手术在扩大 LND 中的作用尚未得到很好的定义。
方法：利用国际机器人膀胱癌切除术联盟（IRCC）数据库，对 2003 年至 2010 年期间在 17 个机构接受 RARC 的 765 例患者进行评估，以评估接受扩大 LND 的情况。患者按年龄、性别、临床分期、机构量、序贯病例数和外科医生量进行分层。采用逻辑回归分析将变量与接受扩大 LND 的可能性相关联。
结果：共有 445 例（58%）患者接受了扩大 LND。在所有患者中，中位数（范围）为 18 个（0-74 个）淋巴结被检查。高容量机构（≥100 例）的平均 LN 产量更高（23 比 15，P<0.001）。单变量分析显示，外科医生量、机构量和序贯病例数与接受扩大 LND 的可能性相关。多变量分析显示，外科医生量[优势比（OR）3.46，95%置信区间（CI）2.37-5.06，P<0.001]和机构量[OR 2.65，95%CI 1.47-4.78，P=0.001]与接受扩大 LND 相关。
结论：机器人辅助 LND 可以在 RC 后达到与开放 LND 相似的 LN 产量。高容量外科医生更有可能进行扩大 LND，这反映了他们不断增加的经验与对高级血管解剖学的日益熟悉之间的相关性。
