1. Surgical margin status after robot assisted radical cystectomy: results from the International Robotic Cystectomy Consortium
- Author
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David K. Ornstein, Abid Hussain, Shamim Khan, Paul E. Andrews, Francis Schanne, Hyung L. Kim, P. Carpentier, Raj S. Pruthi, Erik P. Castle, Adam S. Kibel, Joan Palou, Khurshid A. Guru, Mani Menon, Alex Mottrie, Greg Wilding, Lee Richstone, James O. Peabody, Prokar Dasgupta, Murugesan Manoharan, Jihad H. Kaouk, Nicholas J. Hellenthal, Peter Wiklund, Raju Thomas, and Hans Stricker
- Subjects
Male ,Surgical margin ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Cystectomy ,Predictive Value of Tests ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Lymph node ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Urinary bladder ,business.industry ,Robotics ,Middle Aged ,Prognosis ,Surgery ,medicine.anatomical_structure ,Logistic Models ,Outcome and Process Assessment, Health Care ,Urinary Bladder Neoplasms ,Predictive value of tests ,Lymphatic Metastasis ,T-stage ,Female ,Positive Surgical Margin ,Neoplasm Recurrence, Local ,business - Abstract
Positive surgical margins at radical cystectomy confer a poor prognosis. We evaluated the incidence and predictors of positive surgical margins in patients who underwent robot assisted radical cystectomy for bladder cancer.Using the International Robotic Cystectomy Consortium database we identified 513 patients who underwent robot assisted radical cystectomy, as done by a total of 22 surgeons at 15 institutions from 2003 to 2009. After stratification by age group, gender, pathological T stage, nodal status, sequential case number and institutional volume logistic regression was used to correlate variables with the likelihood of a positive surgical margin.Of the 513 patients 35 (6.8%) had a positive surgical margin. Increasing 10-year age group, lymph node positivity and higher pathological T stage were significantly associated with an increased likelihood of a positive margin (p = 0.010,0.001 and p0.001, respectively). Gender, sequential case number and institutional volume were not significantly associated with margin positivity. The rate of margin positive disease at cystectomy was 1.5% for pT2 or less, 8.8% for pT3 and 39% for pT4 disease.Positive surgical margin rates at robot assisted radical cystectomy for advanced bladder cancer were similar to those in open cystectomy series in a large, multi-institutional, prospective cohort. Sequential case number, a surrogate for the learning curve and institutional volume were not significantly associated with positive margins at robot assisted radical cystectomy.
- Published
- 2009