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.
Journal of robotic surgery. 2019 Oct 03 [Epub ahead of print]
Carla M Miguel, Kaitlin E Kosinski, Melissa J Fazzari, Michael Kongnyuy, Marc C Smaldone, Jeffrey T Schiff, Aaron E Katz, Anthony T Corcoran
Department of Urology, NYU-Winthrop Hospital, 1300 Franklin Ave, Garden City, Mineola, NY, 11530, USA., Department of Biostatistics, NYU-Winthrop Hospital, Mineola, NY, USA., Division of Urologic Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA., Department of Urology, NYU-Winthrop Hospital, 1300 Franklin Ave, Garden City, Mineola, NY, 11530, USA. .