398 SUBJECTIVITY IN MEASURING THE QUALITY OF PELVIC LYMPH NODE DISSECTION BY THE NUMBER OF LYMPH NODES REMOVED

Abstract

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010398 SUBJECTIVITY IN MEASURING THE QUALITY OF PELVIC LYMPH NODE DISSECTION BY THE NUMBER OF LYMPH NODES REMOVED Karim Touijer, Caroline Savage, James Eastham, Peter Scardino, and Bertrand Guillonneau Karim TouijerKarim Touijer More articles by this author , Caroline SavageCaroline Savage More articles by this author , James EasthamJames Eastham More articles by this author , Peter ScardinoPeter Scardino More articles by this author , and Bertrand GuillonneauBertrand Guillonneau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.467AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The correlation between the anatomical extent and number of lymph node (LN) retrieval during radical prostatectomy has led some investigators to propose a required minimal number of LN to determine the quality of a lymph node dissection (LND). Our aim was to examine the number of LN removed over time for men undergoing a standard pelvic LND during radical prostatectomy METHODS Between February 2005 and September 2009, 2119 patients with clinically localized prostate cancer underwent a standard pelvic LND including the external iliac, hypogastric and obturator fossa nodal groups, during radical prostatectomy. Surgery was performed via an open or laparoscopic approach. Those who were missing data on the number of LN removed (n=17) were excluded, leaving 2102 patients available for analysis. To test whether the number of LN increased over time, we entered the date of each patient's surgery into a linear regression model. To allow for a potential non-linear relationship between the date of surgery and number of LN removed, date of surgery was entered into the model with non-linear terms (restricted cubic splines). To account for potential differences in the patient population over time, we also adjusted for the probability of having a positive LN using the nomogram. RESULTS Overall we did not observe large differences in the number of LN removed between 2005 and 2008 (median 13; IQR 9, 19). From 2008 onward, there appears to be a large increase in the number of LN removed (median 18; IQR 12, 26). When the date of surgery was included as a predictor of the number of LN, it was highly significant (p<0.001; Figure). Adjustment for the probability of having a positive LN did not importantly change the results. The anatomical template of the LND, the specimen submission and pathological assessment were unchanged during the study period. However, the nodal yield increase in the later part of the study coincides with an increase in the academic interest in LND and metastasis in prostate cancer department wide. CONCLUSIONS Although a good surrogate of the quality of lymph node dissection, the number of lymph node retrieved in our databases in general is influenced by a number of subjective factors often unaccounted for in the scientific analyses conducted. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e157-e158 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karim Touijer More articles by this author Caroline Savage More articles by this author James Eastham More articles by this author Peter Scardino More articles by this author Bertrand Guillonneau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...