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Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis.

Abstract：

BACKGROUND:The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns. AIMS:This study compares practice patterns in utilization of PLND between Indian and United States (US) practices. SETTINGS AND DESIGN:We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database. SUBJECTS AND METHODS:Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk. RESULTS:Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends. CONCLUSIONS:Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.

journal_name

Indian J Cancer

journal_title

Indian journal of cancer

authors

Abdollah F,Arora S,Jindal T,Gild P,Sood A,Yuvaraja TB,Ahlawat RK,Gupta NP,Bhandari M,Menon M

doi

10.4103/ijc.IJC_227_17

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

421-425

issue

eissn

0019-509X

issn

1998-4774

pii

IndianJournalofCancer_2017_54_2_421_225794

journal_volume

pub_type

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Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis.