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Minimally Invasive Versus Open Approach for Cystectomy: Trends in the Utilization and Demographic or Clinical

Andrew G Bachman¹, Alexander A Parker¹, Marshall D Shaw¹

¹University of Oklahoma Health Science Center, Oklahoma City, OK.

|February 20, 2017

Summary

Minimally invasive surgery for bladder cancer (cystectomy) is increasingly common, with its use rising nationally. Factors like male sex, earlier disease stage, and specific insurance types predict its adoption.

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Area of Science:

Urology
Surgical Oncology
Health Services Research

Background:

Cystectomy is a major surgery for bladder cancer.
Surgical approach (open vs. minimally invasive) may impact outcomes.
Trends in surgical approach adoption are not well-defined nationally.

Purpose of the Study:

To analyze national trends in cystectomy operative approach (open vs. minimally invasive).
To identify patient and hospital factors associated with minimally invasive surgery (MIS) for cystectomy.

Main Methods:

Retrospective cohort study using the National Cancer Database (2010-2013).
Analysis of 9439 patients undergoing cystectomy for bladder cancer.
Stratification by open, robotic, or laparoscopic approaches; statistical analysis of predictors for MIS.

Main Results:

Minimally invasive approach (MIA) use increased from 26.3% (2010) to 39.4% (2013).
34.1% of patients received MIA overall.
Independent predictors of MIA included: later year, male sex, lower T stage, private insurance, non-academic centers, neoadjuvant chemotherapy, and lower hospital volume.

Conclusions:

National utilization of MIA for cystectomy has significantly increased.
Factors associated with MIA include male sex, localized disease, neoadjuvant chemotherapy, and treatment at lower-volume, non-academic centers.