Login to Access Video or Poster Abstract: MP58-18
Sources of Funding: None

Introduction

Lymph node yield after cystectomy has been proposed as a quality measure for surgeons, but multiple factors beyond surgeon ability are known to impact node count. We previously demonstrated no difference in nodal yield between open and robotic cystectomy (RC) at a single, high-volume academic institution. We now assessed whether institutional variations in specimen processing can impact nodal yield following RC, as has been shown with open surgery, since this could help explain wide variations in yields between institutions performing RC even with similar templates.

Methods

Consecutive robotic cystectomy procedures performed by a single surgeon with the same assistant were retrospectively reviewed. All procedures were performed with an identical technique and extended template but at two different hospitals including one high-volume academic center with a standardized protocol for node assessment (site A) and one low-volume community hospital (site B). Nodes were dissected en bloc and submitted as no more than one or two specimens.

Results

A total of 57 procedures were performed at site A and 44 at site B. Neoadjuvant chemotherapy was given in 40% of site A and 27% of site B patients (p=0.04). Mean body mass index was 29kg/m^2 at site A and 27kg/m^2 at site B (p=0.09). Despite an identical surgical team, technique, and template, a significant difference in mean node count was identified between the two hospitals with a mean of 34 nodes (range 10-67) at site A and 22 nodes (range 7-40) at site B (p<0.01). There was no difference in the proportion of patients found to have involved lymph nodes on pathologic examination at 32% and 32%, respectively (p=0.73). There was also no difference in the mean number of involved nodes identified per patient in those with metastasis (4 vs 6, p=0.47).

Conclusions

Variations in nodal yield with RC can be related to differences in institutional handling of nodal specimens. The wide differences in node counts between surgeons performing RC with similar templates may depend more on variations in their pathology departments rather than surgeon ability. This has implications for using nodal yield as a surrogate for the quality of surgery and for comparing node counts between surgeons or between open and robotic surgery at different institutions.

Funding

None