Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy

Michael Owyong, Tulay Sengul, Feng Miao, Shirin Razdan, Kevin J. Moore, Mahmoud Alameddine, Sanoj Punnen, Dipen J Parekh, Chad 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

Fingerprint

Cystectomy
Robotics
Neoplasms
Logistic Models
Margins of Excision
Urinary Bladder Neoplasms
Databases
Muscles

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy. / Owyong, Michael; Sengul, Tulay; Miao, Feng; Razdan, Shirin; Moore, Kevin J.; Alameddine, Mahmoud; Punnen, Sanoj; Parekh, Dipen J; Ritch, Chad; Gonzalgo, Mark L.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2019.

Research output: Contribution to journalArticle

@article{b6768ec985554b48acda04af6cf0288f,
title = "Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy",
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.",
keywords = "Cystectomy, Margins of excision, Outcome and process assessment (health care), Urinary bladder neoplasm, Urologic surgical procedures",
author = "Michael Owyong and Tulay Sengul and Feng Miao and Shirin Razdan and Moore, {Kevin J.} and Mahmoud Alameddine and Sanoj Punnen and Parekh, {Dipen J} and Chad Ritch and Gonzalgo, {Mark L}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2019.07.018",
language = "English (US)",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy

AU - Owyong, Michael

AU - Sengul, Tulay

AU - Miao, Feng

AU - Razdan, Shirin

AU - Moore, Kevin J.

AU - Alameddine, Mahmoud

AU - Punnen, Sanoj

AU - Parekh, Dipen J

AU - Ritch, Chad

AU - Gonzalgo, Mark L

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cystectomy

KW - Margins of excision

KW - Outcome and process assessment (health care)

KW - Urinary bladder neoplasm

KW - Urologic surgical procedures

UR - http://www.scopus.com/inward/record.url?scp=85070919497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070919497&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2019.07.018

DO - 10.1016/j.urolonc.2019.07.018

M3 - Article

C2 - 31445895

AN - SCOPUS:85070919497

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

SN - 1078-1439

ER -