The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the "post-dissemination" period.
Eur J Surg Oncol
; 40(9): 1080-6, 2014 Sep.
Article
en En
| MEDLINE
| ID: mdl-24411705
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.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Prostatectomía
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Neoplasias de la Próstata
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Robótica
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Adenocarcinoma
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Escisión del Ganglio Linfático
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Ganglios Linfáticos
Tipo de estudio:
Guideline
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Prognostic_studies
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Risk_factors_studies
/
Sysrev_observational_studies
Idioma:
En
Revista:
Eur J Surg Oncol
Asunto de la revista:
NEOPLASIAS
Año:
2014
Tipo del documento:
Article