Effect of healthcare provider characteristics on nodal yield at radical cystectomy

Current evidence suggests that patient outcomes after radical cystectomy are dependent on nodal yield, even in cases of node-negative disease. We hypothesized that the final lymph node (LN) counts would be associated with the service provider (surgeon, pathologist) and the level of experience of the provider's assistant.

We reviewed a series of 89 consecutive patients who had undergone cystectomy from 2001 to 2005 for the effect of provider factors on LN counts. The effect of the surgeon was assessed on an individual basis and the effect of the pathologist was determined according to the uropathologic subspecialization. Provider assistant experience was classified according to the training level of the surgical assistant and the caseload volume of the pathology assistant. Multivariate linear regression analysis, controlling for patient factors, number of nodal packets, and margin status, was used to determine the provider factors associated with the final nodal counts.

The median number of LNs harvested was 14 per patient. On univariate analyses, the individual surgeon and the number of nodal packets submitted were significantly associated with nodal yield (P <0.001 for both). Surgical margin status was also significant (P = 0.003), with fewer LNs collected from those with margin-positive disease. On multivariate linear regression analysis, only surgeon (P = 0.01) and number of packets (P < 0.001; with more LNs taken with more packets) remained statistically significant.

The results of our study have shown that the nodal yield from radical cystectomy is dependent on surgeon-specific factors (the number of packets submitted and the operating surgeon). The patient or pathology service providers did not influence the ultimate LN counts.