Abstract
Introduction Previous series during the dissemination era of minimally invasive techniques for treatment of prostate cancer (PCa) showed a declining use of pelvic lymph node dissection (PLND). The aim of our study was to re-assess the impact of robot-assisted radical prostatectomy (RARP) on the utilization rate of PLND and its extent in the post-dissemination period. Methods Relying on the Surveillance Epidemiology and End Results (SEER) Medicare-linked database, 5804 patients with non-metastatic PCa undergoing open radical prostatectomy (ORP) or RARP between years 2008 and 2009 were identified. Uni- and multivariable logistic regression analyses tested the relationship between surgical approach (RARP vs. ORP) and: 1 - the rate of PLND (pNx vs. pN0-1); and 2 - the extent of PLND (limited vs. extended). Results Overall, 3357 (57.8%) patients underwent a PLND. The proportion of patients treated with PLND was significantly higher among ORP vs. RARP patients: 71.2 vs. 48.6%, respectively (P <0.001). In addition, the median number of lymph nodes removed was significantly higher for patients treated with ORP vs. RARP: 5 vs. 4, respectively (P <0.001). In multivariable analyses, ORP was associated with 2.7- and 1.3-fold higher odds of undergoing PLND and of receiving an extended PLND compared to RARP, respectively (both P ≤ 0.001). Stratified analyses according to disease risk classifications revealed similar trends. Conclusions In the post-dissemination era, RARP remains associated with a decreased use of PLND and suboptimum extent. Efforts should be made to improve guideline adherence in performing a PLND whenever indicated according to tumor aggressiveness, despite surgical approach.
| Original language | English |
|---|---|
| Pages (from-to) | 1080-1086 |
| Number of pages | 7 |
| Journal | European Journal of Surgical Oncology |
| Volume | 40 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 2014 |
Fingerprint
Keywords
- Pelvic lymph node dissection
- Prostate cancer
- Radical prostatectomy
- Robotic-assisted radical prostatectomy
- Staging
ASJC Scopus subject areas
- Oncology
- Surgery
Cite this
The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the "post-dissemination" period. / Gandaglia, G.; Trinh, Q. D.; Hu, J. C.; Schiffmann, J.; Becker, A.; Roghmann, F.; Popa, I.; Tian, Z.; Perrotte, P.; Montorsi, F.; Briganti, A.; Karakiewicz, P. I.; Sun, M.; Abdollah, F.
In: European Journal of Surgical Oncology, Vol. 40, No. 9, 2014, p. 1080-1086.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the "post-dissemination" period
AU - Gandaglia, G.
AU - Trinh, Q. D.
AU - Hu, J. C.
AU - Schiffmann, J.
AU - Becker, A.
AU - Roghmann, F.
AU - Popa, I.
AU - Tian, Z.
AU - Perrotte, P.
AU - Montorsi, F.
AU - Briganti, A.
AU - Karakiewicz, P. I.
AU - Sun, M.
AU - Abdollah, F.
PY - 2014
Y1 - 2014
N2 - Introduction Previous series during the dissemination era of minimally invasive techniques for treatment of prostate cancer (PCa) showed a declining use of pelvic lymph node dissection (PLND). The aim of our study was to re-assess the impact of robot-assisted radical prostatectomy (RARP) on the utilization rate of PLND and its extent in the post-dissemination period. Methods Relying on the Surveillance Epidemiology and End Results (SEER) Medicare-linked database, 5804 patients with non-metastatic PCa undergoing open radical prostatectomy (ORP) or RARP between years 2008 and 2009 were identified. Uni- and multivariable logistic regression analyses tested the relationship between surgical approach (RARP vs. ORP) and: 1 - the rate of PLND (pNx vs. pN0-1); and 2 - the extent of PLND (limited vs. extended). Results Overall, 3357 (57.8%) patients underwent a PLND. The proportion of patients treated with PLND was significantly higher among ORP vs. RARP patients: 71.2 vs. 48.6%, respectively (P <0.001). In addition, the median number of lymph nodes removed was significantly higher for patients treated with ORP vs. RARP: 5 vs. 4, respectively (P <0.001). In multivariable analyses, ORP was associated with 2.7- and 1.3-fold higher odds of undergoing PLND and of receiving an extended PLND compared to RARP, respectively (both P ≤ 0.001). Stratified analyses according to disease risk classifications revealed similar trends. Conclusions In the post-dissemination era, RARP remains associated with a decreased use of PLND and suboptimum extent. Efforts should be made to improve guideline adherence in performing a PLND whenever indicated according to tumor aggressiveness, despite surgical approach.
AB - Introduction Previous series during the dissemination era of minimally invasive techniques for treatment of prostate cancer (PCa) showed a declining use of pelvic lymph node dissection (PLND). The aim of our study was to re-assess the impact of robot-assisted radical prostatectomy (RARP) on the utilization rate of PLND and its extent in the post-dissemination period. Methods Relying on the Surveillance Epidemiology and End Results (SEER) Medicare-linked database, 5804 patients with non-metastatic PCa undergoing open radical prostatectomy (ORP) or RARP between years 2008 and 2009 were identified. Uni- and multivariable logistic regression analyses tested the relationship between surgical approach (RARP vs. ORP) and: 1 - the rate of PLND (pNx vs. pN0-1); and 2 - the extent of PLND (limited vs. extended). Results Overall, 3357 (57.8%) patients underwent a PLND. The proportion of patients treated with PLND was significantly higher among ORP vs. RARP patients: 71.2 vs. 48.6%, respectively (P <0.001). In addition, the median number of lymph nodes removed was significantly higher for patients treated with ORP vs. RARP: 5 vs. 4, respectively (P <0.001). In multivariable analyses, ORP was associated with 2.7- and 1.3-fold higher odds of undergoing PLND and of receiving an extended PLND compared to RARP, respectively (both P ≤ 0.001). Stratified analyses according to disease risk classifications revealed similar trends. Conclusions In the post-dissemination era, RARP remains associated with a decreased use of PLND and suboptimum extent. Efforts should be made to improve guideline adherence in performing a PLND whenever indicated according to tumor aggressiveness, despite surgical approach.
KW - Pelvic lymph node dissection
KW - Prostate cancer
KW - Radical prostatectomy
KW - Robotic-assisted radical prostatectomy
KW - Staging
UR - http://www.scopus.com/inward/record.url?scp=84905899441&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84905899441&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2013.12.016
DO - 10.1016/j.ejso.2013.12.016
M3 - Article
C2 - 24411705
AN - SCOPUS:84905899441
VL - 40
SP - 1080
EP - 1086
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
SN - 0748-7983
IS - 9
ER -