PMID- 18514383
OWN - NLM
STAT- MEDLINE
DCOM- 20090115
LR  - 20090714
IS  - 0302-2838 (Print)
IS  - 0302-2838 (Linking)
VI  - 54
IP  - 4
DP  - 2008 Oct
TI  - Impact of surgical volume on the rate of lymph node metastases in patients 
      undergoing radical prostatectomy and extended pelvic lymph node dissection for 
      clinically localized prostate cancer.
PG  - 794-802
LID - 10.1016/j.eururo.2008.05.018 [doi]
AB  - BACKGROUND: Previous trials have shown that the number of procedures done by a 
      single surgeon, that is, surgical volume (SV), is associated with several 
      outcomes after radical prostatectomy (RP). OBJECTIVE: To test the association 
      between SV and the detection of lymph node metastases during extended pelvic 
      lymph node dissection (ePLND). DESIGN, SETTING, AND PARTICIPANTS: The study 
      cohort consisted of 1020 men surgically treated for clinically localized prostate 
      cancer. INTERVENTION: All patients underwent RP and ePLND by a group of six 
      surgeons who were trained by the surgeon with the highest SV. All surgeons 
      performed an anatomically extended PLND, including removal of obturator, external 
      iliac, and hypogastric nodes. MEASUREMENTS: Univariable and multivariable 
      logistic regression models tested the association between SV (either continuously 
      coded or dichotomized according to the most informative cut-off, namely >144 vs < 
      or =144 ePLNDs) and the rate of lymph node invasion (LNI) after accounting for 
      preoperative (baseline prostate-specific antigen [PSA], clinical stage, biopsy 
      Gleason sum) and postoperative (pathologic stages and Gleason score, surgical 
      margin status) patient characteristics. RESULTS AND LIMITATIONS: Mean number of 
      nodes removed was 19.1 (median, 16; range, 7-63). Mean overall SV was 227 (range, 
      87-379). Overall, LNI rate was 11.8% (120/1020). No significant differences were 
      found among patients treated by the different surgeons in terms of clinical and 
      pathologic characteristics (all p> or =0.06). Conversely, the surgeon with the 
      highest SV removed more nodes and found more nodal metastases compared with the 
      other surgeons (21.1 vs 17.9 mean number of nodes removed; p<0.001, and 15 vs 
      9.8% of LNI; p=0.01, respectively). At univariable logistic regression analysis, 
      either continuously coded or dichotomized SV was a significant predictor of LNI 
      (p=0.007 and p<0.001, respectively). In multivariable models, continuously coded 
      as well as dichotomized SV maintained a significant association with the rate of 
      LNI, after accounting for preoperative (p=0.04 and p=0.009, respectively) as well 
      as for postoperative variables (p=0.03 and p=0.002, respectively). CONCLUSIONS: 
      After adjusting for clinical and pathologic case-mix differences, patients 
      treated by the highest-volume surgeons (>144 ePLNDs) were more likely to have LNI 
      than those treated by low-volume surgeons, even though all surgeons used a 
      similar extended template for node removal.
FAU - Briganti, Alberto
AU  - Briganti A
AD  - Department of Urology, Vita-Salute University, Milan, Italy. 
      briganti_alberto@yahoo.it
FAU - Capitanio, Umberto
AU  - Capitanio U
FAU - Chun, Felix K-H
AU  - Chun FK
FAU - Gallina, Andrea
AU  - Gallina A
FAU - Suardi, Nazareno
AU  - Suardi N
FAU - Salonia, Andrea
AU  - Salonia A
FAU - Da Pozzo, Luigi F
AU  - Da Pozzo LF
FAU - Colombo, Renzo
AU  - Colombo R
FAU - Di Girolamo, Valerio
AU  - Di Girolamo V
FAU - Bertini, Roberto
AU  - Bertini R
FAU - Guazzoni, Giorgio
AU  - Guazzoni G
FAU - Karakiewicz, Pierre I
AU  - Karakiewicz PI
FAU - Montorsi, Francesco
AU  - Montorsi F
FAU - Rigatti, Patrizio
AU  - Rigatti P
LA  - eng
PT  - Journal Article
DEP - 20080521
PL  - Switzerland
TA  - Eur Urol
JT  - European urology
JID - 7512719
SB  - IM
CIN - Eur Urol. 2008 Oct;54(4):803-4. PMID: 18514382
CIN - Eur Urol. 2008 Oct;54(4):802-3. PMID: 18514384
CIN - Eur Urol. 2008 Oct;54(4):955-6. PMID: 18687518
CIN - Eur Urol. 2009 Feb;55(2):e32-3; author reply e34-5. PMID: 18760527
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Humans
MH  - *Lymph Node Excision
MH  - Lymphatic Metastasis
MH  - Male
MH  - Middle Aged
MH  - Organ Size
MH  - Prospective Studies
MH  - *Prostatectomy
MH  - Prostatic Neoplasms/*pathology/*surgery
EDAT- 2008/06/03 09:00
MHDA- 2009/01/16 09:00
CRDT- 2008/06/03 09:00
PHST- 2008/01/01 00:00 [received]
PHST- 2008/05/07 00:00 [accepted]
PHST- 2008/06/03 09:00 [pubmed]
PHST- 2009/01/16 09:00 [medline]
PHST- 2008/06/03 09:00 [entrez]
AID - S0302-2838(08)00623-4 [pii]
AID - 10.1016/j.eururo.2008.05.018 [doi]
PST - ppublish
SO  - Eur Urol. 2008 Oct;54(4):794-802. doi: 10.1016/j.eururo.2008.05.018. Epub 2008 
      May 21.