Contemporary rates of adherence to international guidelines for pelvic lymph node dissection in radical cystectomy: a population-based study

To examine the rates of adherence to guidelines for pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and to identify predictors of omitting PLND.

We relied on 66,208 patients treated with RC between 2004 and 2013 within the National Inpatients Sample (NIS) database. We examined the rates of PLND according to year of surgery, patient and hospital characteristics. Univariate and multivariate logistic regression analyses assessed the probability of PLND use, after adjusting for year of surgery, age, gender, race, comorbidities, hospital location, teaching status and hospital surgical volume.

Overall, PLND was performed on 54,223 (81.9%) RC patients. The rates PLND at RC significantly increased over the study period from 72.3% in 2004 to 85.9% in 2013, (p < 0.001). Barriers to PLND at RC consisted of female gender (OR: 1.31; 95% CI 1.25-1.38; p < 0.001), African American race (OR: 1.21; 95% CI 1.10-1.32; p < 0.001), intermediate (OR: 1.78; 95% CI 1.68-1.88; p < 0.001) or low surgical volume institutions (OR: 2.59; 95% CI 2.44-2.74; p < 0.001), non-teaching institution status (OR: 1.21; 95% CI 1.15-1.27; p < 0.001) and rural hospital location (OR: 1.13; 95% CI 1.01-1.25; p = 0.03).

It is encouraging to note increasing rates of PLND at RC over time. Both patients and hospital characteristics influence PLND rates. More efforts should be aimed at reducing inequalities in PLND at RC due to these highly modifiable variables.

World journal of urology. 2018 Apr 27 [Epub ahead of print]

Emanuele Zaffuto, Marco Bandini, Stéphanie Gazdovich, Anne-Sophie Valiquette, Sami-Ramzi Leyh-Bannurah, Zhe Tian, Paolo Dell'Oglio, Markus Graefen, Marco Moschini, Andrea Necchi, Shahrokh F Shariat, Alberto Briganti, Francesco Montorsi, Pierre I Karakiewicz

Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada., Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria.