Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy

Michael Owyong, T. Koru-Sengul, Feng Miao, Shirin Razdan, Kevin J. Moore, Mahmoud Alameddine, S. Punnen, Dipen J. Parekh, Chad R. Ritch, Mark L. Gonzalgo

Research output: Contribution to journalArticle

Abstract

Introduction: We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort. Materials and Methods: Patients who underwent partial cystectomy from 2010 to 2014 were identified in the National Cancer Data Base. The primary outcome was surgical margin status. A multivariable logistic regression model was fitted to identify patient, hospital, and surgical factors associated with positive surgical margins (PSMs). Results: Partial cystectomy was performed in 1,118 patients via open (n = 715, 64%), laparoscopic (n = 209, 19%), and robotic (n = 194, 17%) approaches. Overall, 220 (19.7%) patients had PSMs. The PSM rate by surgical approach was 19.6% for open, 18.2% for laparoscopic, and 21.6% for robotic (P = 0.678). Compared to open partial cystectomy, the laparoscopic (aOR 1.06, 95%CI 0.70–1.60, P = 0.782), and robotic (aOR 1.28, 95%CI 0.85–1.91, P = 0.235) approaches were not significantly different in terms of PSM rate. There were higher odds of PSMs in non-Hispanic blacks (aOR 1.93, 95%CI 1.09–3.39, P = 0.023) compared to non-Hispanic whites, and in patients with muscle invasive bladder cancer (aOR 3.28, 95%CI 2.00–5.37, P < 0.001) or tumor size ≥ 3 cm (aOR 1.67, 95%CI 1.21–2.30, P = 0.002). Tumors in a dome/urachal location had lower odds of a PSM compared to tumors in a nondome/urachal location (aOR 0.67, 95%CI 0.47–0.94, P = 0.022). Conclusions: Our results suggest that partial cystectomy using a laparoscopic or robotic-assisted approach is not associated with an increased risk of PSMs compared to open partial cystectomy.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2019

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Keywords

  • Cystectomy
  • Margins of excision
  • Outcome and process assessment (health care)
  • Urinary bladder neoplasm
  • Urologic surgical procedures

ASJC Scopus subject areas

  • Oncology
  • Urology

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