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Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis
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 betwee...
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| Published in: | Journal of robotic surgery 2020-08, Vol.14 (4), p.609-614 |
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| cites | cdi_FETCH-LOGICAL-c400t-264912a12f453001809170ed840b22ad65ace2f75a1c624e2c0a469973d544e53 |
| container_end_page | 614 |
| container_issue | 4 |
| container_start_page | 609 |
| container_title | Journal of robotic surgery |
| container_volume | 14 |
| creator | Miguel, Carla M. Kosinski, Kaitlin E. Fazzari, Melissa J. Kongnyuy, Michael Smaldone, Marc C. Schiff, Jeffrey T. Katz, Aaron E. Corcoran, Anthony T. |
| description | 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
|
| doi_str_mv | 10.1007/s11701-019-01031-z |
| format | article |
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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.</description><identifier>ISSN: 1863-2483</identifier><identifier>EISSN: 1863-2491</identifier><identifier>DOI: 10.1007/s11701-019-01031-z</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Bladder cancer ; Cancer ; Cancer therapies ; Community centers ; Dissection ; Histology ; Hospitals ; Lymphatic system ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Original Article ; Patients ; Regression models ; Robotic surgery ; Surgery ; Trends ; Urological surgery ; Urology ; Variables</subject><ispartof>Journal of robotic surgery, 2020-08, Vol.14 (4), p.609-614</ispartof><rights>Springer-Verlag London Ltd., part of Springer Nature 2019</rights><rights>Springer-Verlag London Ltd., part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-264912a12f453001809170ed840b22ad65ace2f75a1c624e2c0a469973d544e53</citedby><cites>FETCH-LOGICAL-c400t-264912a12f453001809170ed840b22ad65ace2f75a1c624e2c0a469973d544e53</cites><orcidid>0000-0003-1352-0614</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Miguel, Carla M.</creatorcontrib><creatorcontrib>Kosinski, Kaitlin E.</creatorcontrib><creatorcontrib>Fazzari, Melissa J.</creatorcontrib><creatorcontrib>Kongnyuy, Michael</creatorcontrib><creatorcontrib>Smaldone, Marc C.</creatorcontrib><creatorcontrib>Schiff, Jeffrey T.</creatorcontrib><creatorcontrib>Katz, Aaron E.</creatorcontrib><creatorcontrib>Corcoran, Anthony T.</creatorcontrib><title>Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis</title><title>Journal of robotic surgery</title><addtitle>J Robotic Surg</addtitle><description>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.</description><subject>Bladder cancer</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Community centers</subject><subject>Dissection</subject><subject>Histology</subject><subject>Hospitals</subject><subject>Lymphatic system</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Original Article</subject><subject>Patients</subject><subject>Regression models</subject><subject>Robotic surgery</subject><subject>Surgery</subject><subject>Trends</subject><subject>Urological surgery</subject><subject>Urology</subject><subject>Variables</subject><issn>1863-2483</issn><issn>1863-2491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1TAQhSNEJUrLC7CyxIZN6Izt_LFDl1-pAhawtuY6k1tXSZzaTqX0jfqWGC4CxKKLkcej7xyNfYriOcIrBGguImIDWAJ2uUBhefeoOMW2VqXUHT7-07fqSfE0xmuAqqkUnhb3Xyld-dEfnBUTU1wDR-EHcbPS6NImrJ8WCiwGuvWB9uMm3CwWSo7nFMU69xwO3s0HEfzep5JidDFxLwL1ztIo7JavNvlpE8kLv_D878j6Kx9SfC1IfM6efs6KHc2Wg3hLifYUWVAebtn1vDgZaIz87Pd5Vnx__-7b7mN5-eXDp92by9JqgFTKOj9YEspBVwoAW-jy13DfathLSX1dkWU5NBWhraVmaYF03XWN6iutuVJnxcuj7xL8zcoxmclFy-NIM_s1GqkAtVa1rDP64j_02q8h75upDtsGa4QuU_JI2eBjDDyYJbiJwmYQzM_0zDE9k9Mzv9Izd1mkjqKY4fnA4a_1A6of2WGgpw</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Miguel, Carla M.</creator><creator>Kosinski, Kaitlin E.</creator><creator>Fazzari, Melissa J.</creator><creator>Kongnyuy, Michael</creator><creator>Smaldone, Marc C.</creator><creator>Schiff, Jeffrey T.</creator><creator>Katz, Aaron E.</creator><creator>Corcoran, Anthony T.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M7S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1352-0614</orcidid></search><sort><creationdate>20200801</creationdate><title>Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis</title><author>Miguel, Carla M. ; Kosinski, Kaitlin E. ; Fazzari, Melissa J. ; Kongnyuy, Michael ; Smaldone, Marc C. ; Schiff, Jeffrey T. ; Katz, Aaron E. ; Corcoran, Anthony T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-264912a12f453001809170ed840b22ad65ace2f75a1c624e2c0a469973d544e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bladder cancer</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Community centers</topic><topic>Dissection</topic><topic>Histology</topic><topic>Hospitals</topic><topic>Lymphatic system</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Original Article</topic><topic>Patients</topic><topic>Regression models</topic><topic>Robotic surgery</topic><topic>Surgery</topic><topic>Trends</topic><topic>Urological surgery</topic><topic>Urology</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miguel, Carla M.</creatorcontrib><creatorcontrib>Kosinski, Kaitlin E.</creatorcontrib><creatorcontrib>Fazzari, Melissa J.</creatorcontrib><creatorcontrib>Kongnyuy, Michael</creatorcontrib><creatorcontrib>Smaldone, Marc C.</creatorcontrib><creatorcontrib>Schiff, Jeffrey T.</creatorcontrib><creatorcontrib>Katz, Aaron E.</creatorcontrib><creatorcontrib>Corcoran, Anthony T.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Engineering Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Engineering Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of robotic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miguel, Carla M.</au><au>Kosinski, Kaitlin E.</au><au>Fazzari, Melissa J.</au><au>Kongnyuy, Michael</au><au>Smaldone, Marc C.</au><au>Schiff, Jeffrey T.</au><au>Katz, Aaron E.</au><au>Corcoran, Anthony T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis</atitle><jtitle>Journal of robotic surgery</jtitle><stitle>J Robotic Surg</stitle><date>2020-08-01</date><risdate>2020</risdate><volume>14</volume><issue>4</issue><spage>609</spage><epage>614</epage><pages>609-614</pages><issn>1863-2483</issn><eissn>1863-2491</eissn><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.</abstract><cop>London</cop><pub>Springer London</pub><doi>10.1007/s11701-019-01031-z</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1352-0614</orcidid></addata></record> |
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| ispartof | Journal of robotic surgery, 2020-08, Vol.14 (4), p.609-614 |
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| language | eng |
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| source | Springer Nature |
| subjects | Bladder cancer Cancer Cancer therapies Community centers Dissection Histology Hospitals Lymphatic system Medicine Medicine & Public Health Minimally Invasive Surgery Original Article Patients Regression models Robotic surgery Surgery Trends Urological surgery Urology Variables |
| title | Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis |
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