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Development, validation and clinical application of Pelvic Lymphadenectomy Assessment and Completion Evaluation: intraoperative assessment of lymph node dissection after robot‐assisted radical cystectomy for bladder cancer
Author(s) -
Hussein Ahmed A.,
Hinata Nobuyuki,
Dibaj Shiva,
May Paul R.,
Kozlowski Justen D.,
AbolEnein Hassan,
Abaza Ronney,
Eun Daniel,
Khan Mohamed S.,
Mohler James L.,
Agarwal Piyush,
Pohar Kamal,
Sarle Richard,
Boris Ronald,
Mane Sridhar S.,
Hutson Alan,
Guru Khurshid A.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13748
Subject(s) - medicine , cystectomy , lymphadenectomy , dissection (medical) , lymph node , interquartile range , bladder cancer , robotic surgery , urology , surgery , general surgery , cancer
Objectives To develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation ( PLACE ), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection ( PLND ) following robot‐assisted radical cystectomy ( RARC ). Patients, Subjects and Methods A panel of 11 open and robotic surgeons developed the content and structure of PLACE . The PLND template was divided into three zones. In all, 21 de‐identified videos of bilateral robot‐assisted PLND s were assessed by the 11 experts using PLACE to determine inter‐rater reliability. Lymph node ( LN ) clearance was defined as the proportion of cleared LN s from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLND s using PLACE with our retrospective series performed using the extended template (No PLACE ). Results A significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431–545). There was a significant positive correlation between LN clearance and LN count ( R 2 = 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group. Conclusions Pelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC .