Contemporary National Trends and Variations of Pelvic Lymph Node Dissection in Patients Undergoing Robot-Assisted Radical Prostatectomy

Used national cancer database data, we showed significantly increased pelvic lymph node dissection rate in patients who underwent robot-assisted radical prostatectomy for intermediate-risk and high-risk prostate cancer in recent years. There were still some variations in pelvic lymph node dissection rate among different patient populations and facilities. Introduction: Previous studies showed suboptimal adherence to clinical practice guidelines for pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Robot-assisted RP (RARP) has become the predominant surgi-cal management for localized prostate cancer in the United States but contemporary national data on PLND adherence during RARP are still lacking. Methods: RARPs for clinically localized (cT1-2N0M0) intermediate-risk and high-risk prostate cancer diagnosed between 2010 and 2016 in National Cancer Database were identified. Outcome of interest was PLND and multivariable logistic regressions were used to identify whether patient demographics and facility charac-teristics were associated with the outcome. Results: We included 115,355 patients in the final cohort (intermediate-risk = 86,314, high-risk = 29,041). From 2010 to 2016, there was an increasing trend of PLND in the overall, intermediate-r isk, and high-r isk cohorts. In 2016, PLND was performed in 79.7% of the intermediate-risk and 93.5% of the high-risk patients. Multivariable logistic regressions showed Hispanic race/ethnicity (vs. white) (odds ratio [OR] = 0.90, P = .010), lowest socioeconomic status (vs. highest) (OR = 0.85, P < .001), rural area (vs. metro area) (OR = 0.61, P < .001), and communit y facilit y (vs. academic) (OR = 0.56, P < .001) were some of the factors associated with lower PLND rate. Variations of PLND rate among reporting facility's locations were also identified. Conclusion: Contemporary national data showed significantly increased PLND rate in patients who underwent RARP for intermediate-r isk and high-r isk prostate cancer in recent years. However, there were still some variations in PLND rate among different patient popula-tions and facilities. Continued efforts need to be made to further increase PLND rate and narrow or eliminate disparities we identified.