PD14-09 THE IMPACT OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY ON THE USE AND EXTENT OF PELVIC LYMPH NODE DISSECTION IN THE “POST-LEARNING CURVE” ERA

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You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2014PD14-09 THE IMPACT OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY ON THE USE AND EXTENT OF PELVIC LYMPH NODE DISSECTION IN THE “POST-LEARNING CURVE” ERA Giorgio Gandaglia, Quoc-Dien Trinh, Jim Hu, Andreas Becker, Florian Roghmann, Zhe Tian, Paul Perrotte, Francesco Montorsi, Alberto Briganti, Pierre I. Karakiewicz, Maxine Sun, and Firas Abdollah Giorgio GandagliaGiorgio Gandaglia More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Jim HuJim Hu More articles by this author , Andreas BeckerAndreas Becker More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Zhe TianZhe Tian More articles by this author , Paul PerrottePaul Perrotte More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Maxine SunMaxine Sun More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1286AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the established advantages associated with extended pelvic lymph node dissection (PLND), several studies reported a disconcerting decrease in the utilization rate of PLND in recent years, even among patients with intermediate- and high-risk prostate cancer (PCa). Many have indicated the advent of minimally invasive surgery, such as robotic-assisted radical prostatectomy (RARP), which now account for nearly 70% of all radial prostatectomies (RP) performed in the United States, as a predominant reason for declining rates of PLND. To address this issue, we sought to revisit the utilization rate of PLND and its extent in a contemporary population-based cohort of North American men. Of particular interest, we examined the impact of surgical approach (open RP [ORP] vs. RARP) on the use of PLND. METHODS Relying on the Surveillance Epidemiology and End Results Medicare-linked database, 5,804 patients with non-metastatic PCa undergoing ORP or RARP between years 2008 and 2009 were identified. 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 Average age at diagnosis was 69.1 years (median: 68; interquartile range: 66 – 71). Overall, 3,357 (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 Our results indicate that RARP remains associated with absence of PLND and suboptimal extent when performed even in patients with high-risk tumours. These observations can no longer be attributed to the “learning-curve” period. Efforts should be made to improve guideline adherence in performing a PLND whenever indicated according to tumour aggressiveness, despite surgical approach. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e414 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Giorgio Gandaglia More articles by this author Quoc-Dien Trinh More articles by this author Jim Hu More articles by this author Andreas Becker More articles by this author Florian Roghmann More a