Rates and Predictors of Conversion to Open Surgery during Minimally Invasive Radical Cystectomy

Oliver S. Ko, Adam B. Weiner, Norm D. Smith, Joshua J Meeks*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To assess the frequency of minimally invasive radical cystectomy (MIRC) conversion to open surgery, what factors influence conversion, whether or not the benefits of MIRC vs open radical cystectomy (ORC) persist after conversion, and compare ORC and MIRC outcomes. Materials and Methods: We performed a retrospective cohort study from the National Cancer Data Base (2010 to 2013) analyzing patients who underwent completed MIRC (n = 5750), converted MIRC (n = 245), and ORC (n = 12,053) without prior radiotherapy. Multivariable logistic and linear regression analyses were used to assess the association between covariates, open conversion as well as surgical approach, and secondary outcomes such as positive surgical margins (PSMs), use of lymphadenectomy, lymph node yield, hospital length of stay (LOS), and 30-day readmission. Results: Rates of conversion were independent of patient factors such as race, sex, use of neoadjuvant chemotherapy, and clinical stage. Conversion occurred in 245 of 5750 MIRCs (4.3%) and declined over time (5.8% in 2010 vs 3.2% in 2013, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.75, p = 0.001). MIRC was associated with fewer positive margins, higher lymph node yield, shorter LOS, and fewer readmissions compared with ORC, however, patients requiring open conversion had longer median hospital stays (8 days vs 7 days, p = 0.013), lower median lymph node yields (14 vs 17, p = 0.007), more PSMs (17% vs 11%, p = 0.006), and more 30-day readmissions (14% vs 9%, p = 0.008) compared to nonconverted. Converted MIRC had similar hospital LOS and 30-day readmission rates compared to ORC. Conclusion: Open conversion during MIRC is uncommon and has decreased in recent years despite the rising use of MIRC. MIRC had better short-term outcomes compared with ORC. These benefits were negated with open conversion; however, outcomes were similar compared to planned ORC.

Original languageEnglish (US)
Pages (from-to)488-494
Number of pages7
JournalJournal of Endourology
Volume32
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Conversion to Open Surgery
Cystectomy
Length of Stay
Lymph Nodes

Keywords

  • bladder cancer
  • laparoscopy
  • minimally invasive approaches
  • radical cystectomy
  • robotics

ASJC Scopus subject areas

  • Urology

Cite this

Ko, Oliver S. ; Weiner, Adam B. ; Smith, Norm D. ; Meeks, Joshua J. / Rates and Predictors of Conversion to Open Surgery during Minimally Invasive Radical Cystectomy. In: Journal of Endourology. 2018 ; Vol. 32, No. 6. pp. 488-494.
@article{ded73829284a4d2aa9ebc852f8624f0e,
title = "Rates and Predictors of Conversion to Open Surgery during Minimally Invasive Radical Cystectomy",
abstract = "Objective: To assess the frequency of minimally invasive radical cystectomy (MIRC) conversion to open surgery, what factors influence conversion, whether or not the benefits of MIRC vs open radical cystectomy (ORC) persist after conversion, and compare ORC and MIRC outcomes. Materials and Methods: We performed a retrospective cohort study from the National Cancer Data Base (2010 to 2013) analyzing patients who underwent completed MIRC (n = 5750), converted MIRC (n = 245), and ORC (n = 12,053) without prior radiotherapy. Multivariable logistic and linear regression analyses were used to assess the association between covariates, open conversion as well as surgical approach, and secondary outcomes such as positive surgical margins (PSMs), use of lymphadenectomy, lymph node yield, hospital length of stay (LOS), and 30-day readmission. Results: Rates of conversion were independent of patient factors such as race, sex, use of neoadjuvant chemotherapy, and clinical stage. Conversion occurred in 245 of 5750 MIRCs (4.3{\%}) and declined over time (5.8{\%} in 2010 vs 3.2{\%} in 2013, odds ratio [OR] 0.50, 95{\%} confidence interval [CI] 0.34-0.75, p = 0.001). MIRC was associated with fewer positive margins, higher lymph node yield, shorter LOS, and fewer readmissions compared with ORC, however, patients requiring open conversion had longer median hospital stays (8 days vs 7 days, p = 0.013), lower median lymph node yields (14 vs 17, p = 0.007), more PSMs (17{\%} vs 11{\%}, p = 0.006), and more 30-day readmissions (14{\%} vs 9{\%}, p = 0.008) compared to nonconverted. Converted MIRC had similar hospital LOS and 30-day readmission rates compared to ORC. Conclusion: Open conversion during MIRC is uncommon and has decreased in recent years despite the rising use of MIRC. MIRC had better short-term outcomes compared with ORC. These benefits were negated with open conversion; however, outcomes were similar compared to planned ORC.",
keywords = "bladder cancer, laparoscopy, minimally invasive approaches, radical cystectomy, robotics",
author = "Ko, {Oliver S.} and Weiner, {Adam B.} and Smith, {Norm D.} and Meeks, {Joshua J}",
year = "2018",
month = "6",
day = "1",
doi = "10.1089/end.2018.0079",
language = "English (US)",
volume = "32",
pages = "488--494",
journal = "Journal of Endourology",
issn = "0892-7790",
publisher = "Mary Ann Liebert Inc.",
number = "6",

}

Rates and Predictors of Conversion to Open Surgery during Minimally Invasive Radical Cystectomy. / Ko, Oliver S.; Weiner, Adam B.; Smith, Norm D.; Meeks, Joshua J.

In: Journal of Endourology, Vol. 32, No. 6, 01.06.2018, p. 488-494.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Rates and Predictors of Conversion to Open Surgery during Minimally Invasive Radical Cystectomy

AU - Ko, Oliver S.

AU - Weiner, Adam B.

AU - Smith, Norm D.

AU - Meeks, Joshua J

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Objective: To assess the frequency of minimally invasive radical cystectomy (MIRC) conversion to open surgery, what factors influence conversion, whether or not the benefits of MIRC vs open radical cystectomy (ORC) persist after conversion, and compare ORC and MIRC outcomes. Materials and Methods: We performed a retrospective cohort study from the National Cancer Data Base (2010 to 2013) analyzing patients who underwent completed MIRC (n = 5750), converted MIRC (n = 245), and ORC (n = 12,053) without prior radiotherapy. Multivariable logistic and linear regression analyses were used to assess the association between covariates, open conversion as well as surgical approach, and secondary outcomes such as positive surgical margins (PSMs), use of lymphadenectomy, lymph node yield, hospital length of stay (LOS), and 30-day readmission. Results: Rates of conversion were independent of patient factors such as race, sex, use of neoadjuvant chemotherapy, and clinical stage. Conversion occurred in 245 of 5750 MIRCs (4.3%) and declined over time (5.8% in 2010 vs 3.2% in 2013, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.75, p = 0.001). MIRC was associated with fewer positive margins, higher lymph node yield, shorter LOS, and fewer readmissions compared with ORC, however, patients requiring open conversion had longer median hospital stays (8 days vs 7 days, p = 0.013), lower median lymph node yields (14 vs 17, p = 0.007), more PSMs (17% vs 11%, p = 0.006), and more 30-day readmissions (14% vs 9%, p = 0.008) compared to nonconverted. Converted MIRC had similar hospital LOS and 30-day readmission rates compared to ORC. Conclusion: Open conversion during MIRC is uncommon and has decreased in recent years despite the rising use of MIRC. MIRC had better short-term outcomes compared with ORC. These benefits were negated with open conversion; however, outcomes were similar compared to planned ORC.

AB - Objective: To assess the frequency of minimally invasive radical cystectomy (MIRC) conversion to open surgery, what factors influence conversion, whether or not the benefits of MIRC vs open radical cystectomy (ORC) persist after conversion, and compare ORC and MIRC outcomes. Materials and Methods: We performed a retrospective cohort study from the National Cancer Data Base (2010 to 2013) analyzing patients who underwent completed MIRC (n = 5750), converted MIRC (n = 245), and ORC (n = 12,053) without prior radiotherapy. Multivariable logistic and linear regression analyses were used to assess the association between covariates, open conversion as well as surgical approach, and secondary outcomes such as positive surgical margins (PSMs), use of lymphadenectomy, lymph node yield, hospital length of stay (LOS), and 30-day readmission. Results: Rates of conversion were independent of patient factors such as race, sex, use of neoadjuvant chemotherapy, and clinical stage. Conversion occurred in 245 of 5750 MIRCs (4.3%) and declined over time (5.8% in 2010 vs 3.2% in 2013, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.75, p = 0.001). MIRC was associated with fewer positive margins, higher lymph node yield, shorter LOS, and fewer readmissions compared with ORC, however, patients requiring open conversion had longer median hospital stays (8 days vs 7 days, p = 0.013), lower median lymph node yields (14 vs 17, p = 0.007), more PSMs (17% vs 11%, p = 0.006), and more 30-day readmissions (14% vs 9%, p = 0.008) compared to nonconverted. Converted MIRC had similar hospital LOS and 30-day readmission rates compared to ORC. Conclusion: Open conversion during MIRC is uncommon and has decreased in recent years despite the rising use of MIRC. MIRC had better short-term outcomes compared with ORC. These benefits were negated with open conversion; however, outcomes were similar compared to planned ORC.

KW - bladder cancer

KW - laparoscopy

KW - minimally invasive approaches

KW - radical cystectomy

KW - robotics

UR - http://www.scopus.com/inward/record.url?scp=85048562699&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048562699&partnerID=8YFLogxK

U2 - 10.1089/end.2018.0079

DO - 10.1089/end.2018.0079

M3 - Article

C2 - 29620960

AN - SCOPUS:85048562699

VL - 32

SP - 488

EP - 494

JO - Journal of Endourology

JF - Journal of Endourology

SN - 0892-7790

IS - 6

ER -