Mp24-17 Practice Patterns in Guideline-Appropriate Pelvic Lymph Node Dissection Omission at Time of Radical Prostatectomy: A Pennsylvania Urologic Regional Collaborative Analysis

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP24)1 May 2024MP24-17 PRACTICE PATTERNS IN GUIDELINE-APPROPRIATE PELVIC LYMPH NODE DISSECTION OMISSION AT TIME OF RADICAL PROSTATECTOMY: A PENNSYLVANIA UROLOGIC REGIONAL COLLABORATIVE ANALYSIS Matthew Epstein and Adam Reese Matthew EpsteinMatthew Epstein and Adam ReeseAdam Reese View All Author Informationhttps://doi.org/10.1097/01.JU.0001008860.46052.c4.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Performing pelvic lymph node dissection (PLND) at time of radical prostatectomy (RP) can be controversial in patients with low risk of lymph node invasion (LNI), where staging and oncologic benefits may be offset by the morbidity of lymphadenectomy. In this study, we analyze trends in guideline-appropriate PLND omission rates over time and the variability in omission rates between surgeons. METHODS: We performed a retrospective analysis of PLND omission at time of RP performed on patients who had nomogram predicted risk of LNI<2%, the lowest recommended National Comprehensive Cancer Network (NCCN) threshold. Data was obtained from the Pennsylvania Urologic Regional Collaborative (PURC) from 2015-2021. The results of three different commonly used nomograms, Briganti, MSKCC, and Partin, were compared. Overall changes in guideline-appropriate PLND omissions over time and individual surgeon PLND omission rates were analyzed. RESULTS: PLND was omitted in 361 (10%), 178 (17%), and 315 (11%) men undergoing RP for nomogram-predicted LNI <2% using the Briganti, MSKCC, and Partin nomograms. 71/120 (59%), 46/86 (53%), and 68/115 (59%) surgeons never omitted PLND for patients with a risk of nomogram-predicted LNI <2%. Weak correlation was found between volume of RP's performed and proportion of PLND omissions for patients with LNI risk <2%. Pearson correlations coefficients were calculated at 0.04, 0.09, and 0.05 for each respective nomogram. A significant increase was seen in the proportion of PLND omitted after 2020 (coinciding with the start of the COVID-19 pandemic) using the Briganti (167/2,641 [6.3%] vs. 140/707 [19.8%]; p<0.001), MSKCC (103/830 [12.4%] vs. 58/159 [19.8%]; p<0.001), and Partin (151/2,153 [7.0%] vs. 117/550,=[21.2%]; p<0.001) nomograms. CONCLUSIONS: PLND was infrequently omitted for patients with predicted LNI risk <2% in PURC. More than half of the surgeons contributing to PURC never omitted PLND when performing RP for a patient with a nomogram-predicted risk <2%. Surgeon likelihood of omitting PLND omission was not correlated with RP volume. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e400 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Matthew Epstein More articles by this author Adam Reese More articles by this author Expand All Advertisement PDF downloadLoading ...