Variation in Pelvic Lymph Node Dissection among Patients Undergoing Radical Prostatectomy by Hospital Characteristics and Surgical Approach: Results from the National Cancer Database

No AccessJournal of UrologyAdult Urology1 Mar 2015Variation in Pelvic Lymph Node Dissection among Patients Undergoing Radical Prostatectomy by Hospital Characteristics and Surgical Approach: Results from the National Cancer Database Elyn H. Wang, James B. Yu, Cary P. Gross, Marc C. Smaldone, Nilay D. Shah, Quoc-Dien Trinh, Paul L. Nguyen, Maxine Sun, Leona C. Han, and Simon P. Kim Elyn H. WangElyn H. Wang School of Medicine, Yale University, New Haven, Connecticut Financial interest and/or other relationship with Yale University. More articles by this author , James B. YuJames B. Yu Department of Radiation Oncology, Yale University, New Haven, Connecticut Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut Financial interest and/or other relationship with Yale University. More articles by this author , Cary P. GrossCary P. Gross Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut Department of Internal Medicine, Yale University, New Haven, Connecticut Financial interest and/or other relationship with Yale University. More articles by this author , Marc C. SmaldoneMarc C. Smaldone Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania Financial interest and/or other relationship with Fox Chase Cancer Center. More articles by this author , Nilay D. ShahNilay D. Shah Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Mayo Clinic. More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Division of Urologic Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts Financial interest and/or other relationship with Intuitive Surgical and Harvard Medical School More articles by this author , Paul L. NguyenPaul L. Nguyen Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts Financial interest and/or other relationship with Harvard Medical School More articles by this author , Maxine SunMaxine Sun University of Montreal, Montreal, Quebec, Canada Financial interest and/or other relationship with University of Montreal. More articles by this author , Leona C. HanLeona C. Han Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Mayo Clinic. More articles by this author , and Simon P. KimSimon P. Kim Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio Financial interest and/or other relationship with Yale University. Recipient of career development award from the Conquer Cancer Foundation of the American Society of Clinical Oncology. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.09.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Clinical practice guidelines recommend pelvic lymph node dissection at the time of surgery for intermediate or high risk prostate cancer. Therefore, we examined the relationship of pelvic lymph node dissection and detection of lymph node metastasis with hospital characteristics and surgical approach among patients with prostate cancer. Materials and Methods: Using the National Cancer Data Base we identified surgically treated patients with pretreatment intermediate or high risk disease from 2010 to 2011. Primary outcomes were treatment with pelvic lymph node dissection and extended pelvic lymph node dissection, as well as the detection of lymph node metastasis. Multivariate logistic regression models were used to test whether hospital characteristics and surgical approach were associated with each outcome. Results: Among the 50,671 surgically treated patients 70.8% (35,876) underwent concomitant pelvic lymph node dissection, 26.6% (9,543) underwent extended pelvic lymph node dissection and 4.5% (1,621) had lymph node metastasis. Pelvic lymph node dissection was performed more often at high volume vs low volume hospitals (81.2% vs 65.4%, adjusted OR 2.20, p=0.01), but less frequently with robotic assisted radical prostatectomy vs open radical prostatectomy (67.5% vs 81.8%, adjusted OR 0.30, p <0.001). Higher odds ratios for lymph node metastasis were also demonstrated with high vs low volume (OR 1.35, p=0.01) and academic vs community hospitals (OR 1.35, p <0.001). However, patients treated with robotic assisted radical prostatectomy had lower odds ratios for lymph node metastasis compared to those undergoing open radical prostatectomy (OR 0.56, p <0.001). Conclusions: In this cohort a third of patients are not receiving guideline recommended treatment with pelvic lymph node dissection for prostate cancer. Pelvic lymph node dissection and detection of lymph node metastasis varied by surgical approach, hospital volume and academic status. References 1 : Cancer statistics, 2014. CA Cancer J Clin2014; 64: 9. Google Scholar 2 : Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol2007; 177: 2106. Link, Google Scholar 3 : Prostate cancer, version 2.2014. J Natl Compr Canc Netw2014; 12: 686. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChang P, Wagner A, Regan M, Smith J, Saigal C, Litwin M, Hu J, Cooperberg M, Carroll P, Klein E, Kibel A, Andriole G, Han M, Partin A, Wood D, Crociani C, Greenfield T, Patil D, Hembroff L, Davis K, Stork L, Spratt D, Wei J and Sanda M (2021) Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 ConsortiumJournal of Urology, VOL. 207, NO. 1, (127-136), Online publication date: 1-Jan-2022.Xia L, Sperling C, Taylor B, Talwar R, Chelluri R, Raman J, Lee D, Lee D and Guzzo T (2019) Associations between Hospital Volume and Outcomes of Robot-Assisted Radical ProstatectomyJournal of Urology, VOL. 203, NO. 5, (926-932), Online publication date: 1-May-2020. Volume 193Issue 3March 2015Page: 820-825Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsquality of health carelymph node excisionroboticsprostatectomytreatment outcomeMetricsAuthor Information Elyn H. Wang School of Medicine, Yale University, New Haven, Connecticut Financial interest and/or other relationship with Yale University. More articles by this author James B. Yu Department of Radiation Oncology, Yale University, New Haven, Connecticut Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut Financial interest and/or other relationship with Yale University. More articles by this author Cary P. Gross Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut Department of Internal Medicine, Yale University, New Haven, Connecticut Financial interest and/or other relationship with Yale University. More articles by this author Marc C. Smaldone Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania Financial interest and/or other relationship with Fox Chase Cancer Center. More articles by this author Nilay D. Shah Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Mayo Clinic. More articles by this author Quoc-Dien Trinh Division of Urologic Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts Financial interest and/or other relationship with Intuitive Surgical and Harvard Medical School More articles by this author Paul L. Nguyen Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts Financial interest and/or other relationship with Harvard Medical School More articles by this author Maxine Sun University of Montreal, Montreal, Quebec, Canada Financial interest and/or other relationship with University of Montreal. More articles by this author Leona C. Han Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Mayo Clinic. More articles by this author Simon P. Kim Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio Financial interest and/or other relationship with Yale University. Recipient of career development award from the Conquer Cancer Foundation of the American Society of Clinical Oncology. More articles by this author Expand All Advertisement PDF downloadLoading ...