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Miguel CM , Kosinski KE , Fazzari MJ , Kongnyuy M , Smaldone MC , Schiff JT , Katz AE , Corcoran AT
Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis
J Robot Surg. 2020 Aug;14(4) :609-614
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Abstract
This study aims to assess the impact of facility characteristics on measures of surgical quality (positive surgical margin rates and lymph-node yield) in patients undergoing robot-assisted (RARC) versus open (ORC) radical cystectomy using the National Cancer Database. Patients who received RC between the years of 2010-2013 were stratified according to surgery type (ORC vs. RARC), and corresponding patient and facility-level variables (facility type and volume) were assessed. Logistic regression models for procedure type, positive surgical margins (PSMs), and LN dissection (LND) rates were estimated. Radical cystectomies (ORC = 13,236, RARC = 3687) were performed more often in academic centers (58.3%) compared to community centers (31.6%). As facility volume increased, centers performed more LNDs during ORCs (p = 0.03) and the number of nodes retrieved increased in both ORC and RARC (ORC p < 0.001; RARC p < 0.0001). Increased facility volume also resulted in significantly fewer PSMs within the RARC cohort (p = 0.01). Comparison of ORC and RARC within each facility type cohort identified improved pathological metrics for RARC with fewer PSMs (p = 0.001) as well as increased LNDs (p < 0.0001) and median number of LNs retrieved (p < 0.0001), which suggests that RARC may facilitate comparative outcomes in community centers and academic centers. Overall, higher facility volume and robot-assisted surgery resulted in more favorable pathologic metrics compared to lower facility volume and ORC.
Notes
1863-2491 Miguel, Carla M ORCID: http://orcid.org/0000-0003-1352-0614 Kosinski, Kaitlin E Fazzari, Melissa J Kongnyuy, Michael Smaldone, Marc C Schiff, Jeffrey T Katz, Aaron E Corcoran, Anthony T Journal Article England J Robot Surg. 2019 Oct 3. pii: 10.1007/s11701-019-01031-z. doi: 10.1007/s11701-019-01031-z.