Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Dec;37(12):870-876.
doi: 10.1016/j.urolonc.2019.07.018. Epub 2019 Aug 21.

Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy

Michael Owyong  1 , Tulay Koru-Sengul  2 , Feng Miao  3 , Shirin Razdan  1 , Kevin J Moore  4 , Mahmoud Alameddine  1 , Sanoj Punnen  5 , Dipen J Parekh  5 , Chad R Ritch  5 , Mark L Gonzalgo  6
Affiliations
Comparative Study

Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy

Michael Owyong et al. Urol Oncol. 2019 Dec.

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.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Flow diagram of selection process for final analytical cohort.
Fig. 2.
Fig. 2.
Yearly trend of surgical approach for partial cystectomy from 2010–2014.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7–30. - PubMed
    1. Hollenbeck BK, Taub DA, Dunn RL, Wei JT. Quality of care: partial cystectomy for bladder cancer—a case of inappropriate use? J Urol 2005;174: 1050–4; discussion 4. - PubMed
    1. Faiena I, Dombrovskiy V, Koprowski C, Singer EA, Jang TL, Weiss RE. Performance of partial cystectomy in the United States from 2001 to 2010: trends and comparative outcomes. Can J Urol 2014;21:7520–7. - PMC - PubMed
    1. Chang SS, Bochner BH, Chou R, Dreicer RAM, Lerner SP, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol 2017;198:552–9. - PMC - PubMed
    1. NCC Network. Bladder cancer: NCCN Clinical Practice Guideline in Oncology (NCN GuidelineTM) Version 2.2017. National Comprehensive Cancer Network; 2017.

Publication types