Adverse In-hospital Outcomes According to Pelvic Lymph Node Dissection at Partial Cystectomy

This study was designed to test the association between adverse in-hospital outcomes and pelvic lymph node dissection (PLND) at partial cystectomy (PC) for nonmetastatic bladder cancer (BCa).

We identified patients treated with PC for BCa (National Inpatient Sample 2012-2019). First, estimated annual percentage changes (EAPC) tested temporal trends of PLND at PC. Second, descriptive analyses, propensity score matching (PSM, ratio 1:2) and multivariable logistic regression models (LRMs) were used.

Of 1,289 BCa patients treated with PC, 201 (16.0%) underwent PLND. The rates of PLND at PC decreased from 24.8 to 5.4% over the study span (EAPC - 11.3%; p = 0.01). Pelvic lymph node dissection patients were younger (67 vs. 71 years old; p < 0.001), exhibited a lower number of comorbidities (Charlson Comorbidity Index [CCI] 0: 41% vs. 38%; p = 0.006), and were more frequently admitted to teaching (83% vs. 76%; p = 0.03) and large bedsize (69% vs. 57%; p = 0.004) hospitals. After PSM, 201 of 201 (100%) PLND vs. 402 of 1,088 (36.9%) no-PLND at PC patients were included in further analyses. Pelvic lymph node dissection at PC patients only exhibited significantly higher rate of intraoperative complications (9% vs. 3.7%; p = 0.008), but no statistically significant differences in 13 of 14 other categories were recorded (all p values > 0.09). In multivariable LRMs, PLND independently predicted 2.6-fold higher rate of intraoperative complications (p = 0.01).

The rate of PLND drastically decreased over time. PLND vs. no-PLND at PC only resulted in a moderate increase in intraoperative complications without differences in 13 other adverse in-hospital outcomes, which included complications, in-hospital mortality, length of stay, and total hospital charges.