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Palumbo C, Knipper S, Pecoraro A, Rosiello G, Luzzago S, Deuker M, Tian Z, Shariat SF, Simeone C, Briganti A, Saad F, Berruti A, Antonelli A, Karakiewicz PI. Differences in short-term outcomes between open versus robot-assisted radical cystectomy in frail malnourished patients. Eur J Surg Oncol 2020; 46:1347-1352. [PMID: 32220544 DOI: 10.1016/j.ejso.2020.03.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION We tested whether frail patients may benefit from robot-assisted (RARC) relative to open radical cystectomy (ORC). MATERIALS AND METHODS Frail patients treated with RC were identified within the National Inpatient Sample database (2008-2015). The effect of RARC vs. ORC was tested in five separate multivariable models predicting: complications, failure to rescue (FTR), in-hospital mortality, length of stay (LOS) and total hospital charges (THCs). As internal validity measure, analyses were repeated among non-frail patients. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. RESULTS Of 11,578 RC patients, 3477 (30.0%) were frail. RARC was performed in 488 (14.0%) frail patients and 1386 (17.1%) non-frail patients. Among frail, RARC was only independently associated with shorter LOS (median 8 vs. 9 days, relative ratio [RR] 0.79, p < 0.001). Conversely, among non-frail, RARC was independently associated with lower complications (57.3 vs. 59.1%, odds ratio [OR] 0.82, p = 0.004) and shorter LOS (median 6 vs. 7 days, RR 0.88, p < 0.001), but also predicted higher THCs (+2850.3 US dollars, p = 0.001). CONCLUSIONS In frail patients, the use of RARC did not result in better short-term outcomes except for one-day advantage in LOS. Conversely, in non-frail patients, the use of RARC resulted in lower complication rates and shorter LOS at the cost of higher THCs. In consequence, the benefit of RARC appears relatively marginal in frail patients and our data do not suggest a clear and clinically-meaningful benefit of RARC over ORC in frail radical cystectomy population.
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Affiliation(s)
- Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy.
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW We review historical aspects and current status of the emerging approach of robotic urinary diversion (rUD). Established surgical principles of constructing a low-pressure, large-capacity reservoir are described and the open surgical literature succinctly reviewed to establish the gold standard. Incontinent and continent rUD types [ileal conduit, orthotopic neobladder (all varieties), continent cutaneous diversion, cutaneous ureterostomy] and techniques (extra-corporeal, intra-corporeal) are discussed. Outcomes data (intra-operative, perioperative, intermediate-term, long-term), functional outcomes, complications and learning curve are presented. Outcomes data of open versus robotic urinary diversion are examined. Critiques, improvements, and pros-cons of rUD are discussed. RECENT FINDINGS Although the majority of centers performing rUD use the extracorporeal technique, use of intra-corporeal rUD is increasing. Although data are yet limited, intra-corporeal rUD may provide some benefits. For rUD, operative times are higher and complication rates comparable with open urinary diversion. SUMMARY The entire range of urinary diversion surgery has now been replicated robotically. At this writing, extracorporeal urinary diversion techniques still predominate following robotic cystectomy. However, all rUD options can now be performed intra-corporeally with success. As experience increases, the field of robotic urinary diversion is poised to grow.
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353
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Rios EM, Parma MA, Fernandez RA, Clinton TN, Reyes RM, Kaushik D, Pruthi D, Mansour AM, Mukherjee N, Gelfond J, Wheeler KM, Svatek RS. Urinary Diversion Disparity Following Radical Cystectomy for Bladder Cancer in the Hispanic Population. Urology 2020; 137:66-71. [PMID: 31883879 PMCID: PMC7063861 DOI: 10.1016/j.urology.2019.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine if disparities in quality of surgical care exist between Hispanics and non-Hispanics undergoing radical cystectomy for bladder cancer. MATERIALS AND METHODS An observational cohort study was conducted retrospectively on patients who underwent radical cystectomy for urothelial carcinoma of the bladder at our institution between January 2005 and July 2018. Data was collected on demographic, clinical, and pathological characteristics of patients, including self-reported ethnicity. Univariable and multivariable logistic or linear regression analyses were used to evaluate the association of ethnicity with receipt of neoadjuvant chemotherapy, utilization of laparoscopic surgery, number of lymph nodes removed, and continent urinary diversion. RESULTS We identified 507 patients in our database out of which, 136 (27%) were Hispanic and 371 (73%) were non-Hispanic. Compared to non-Hispanics, Hispanics had a higher body mass index (26.9 kg/m2 vs 28.2 kg/m2, P = .006) and lived further away from site of surgery (34 vs 96 miles, P = .02). No significant differences were observed in receipt of neoadjuvant chemotherapy, laparoscopic surgery, or number of lymph nodes removed during cystectomy between ethnicity groups. However, Hispanics were less likely than non-Hispanics to receive a continent urinary diversion on multivariable analysis (odds ratio 0.30, 95% confidence interval 0.10 - 0.92, P = .03). CONCLUSION Disparity exists in the delivery of continent urinary diversions for Hispanic patients undergoing radical cystectomy for bladder cancer. Further investigation is needed to determine the potential causes for this disparity in care delivered.
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Affiliation(s)
- Emily M Rios
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Mitchell A Parma
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Roman A Fernandez
- Department of Biostatistics, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Timothy N Clinton
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Ryan M Reyes
- Experimental Development Therapeutics Program/Urology, MD Anderson Cancer Center/UT Health Science Center, Houston, TX
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Deepak Pruthi
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Neelam Mukherjee
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX; Experimental Development Therapeutics Program/Urology, MD Anderson Cancer Center/UT Health Science Center, Houston, TX
| | - Jon Gelfond
- Department of Biostatistics, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Karen M Wheeler
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX
| | - Robert S Svatek
- Department of Urology, University of Texas Health San Antonio (UTHSA), San Antonio, TX; Experimental Development Therapeutics Program/Urology, MD Anderson Cancer Center/UT Health Science Center, Houston, TX.
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354
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Jatoi I, Gail MH. The Need for Combined Assessment of Multiple Outcomes in Noninferiority Trials in Oncology. JAMA Oncol 2020; 6:420-424. [PMID: 31830235 DOI: 10.1001/jamaoncol.2019.5361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Noninferiority trials in oncology assess novel therapies with the potential for slightly worse recurrence or death outcomes (ie, the margin of noninferiority) than standard therapies. This poses a dilemma because, in the absence of potential health outcome advantages, these trials may not provide the treatment equipoise required for an ethical study. Any new treatment with the potential for slightly worse recurrence or death outcomes should have countervailing health outcome advantages, but these are rarely taken into account in the design of noninferiority trials. This article presents the argument that not only the potentially worse health outcomes but also the potential benefits of the novel therapy should be considered when designing, analyzing, and reporting noninferiority trials. Some approaches to study design and analysis that consider both primary and secondary end points are discussed, and reporting the joint distributions of end points for the novel and standard treatments is recommended.
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Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health, San Antonio
| | - Mitchell H Gail
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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355
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Gergelis KR, Kreofsky CR, Choo CS, Viehman J, Harmsen WS, Lester SC, Pisansky TM, Davis BJ, Stish BJ, Choo R. Outcomes and Profiles of Older Patients Receiving Definitive Radiation Therapy for Muscle-Invasive Bladder Cancer at a Tertiary Medical Center. Pract Radiat Oncol 2020; 10:e378-e387. [PMID: 32109600 DOI: 10.1016/j.prro.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Our purpose was to evaluate the outcomes and profiles of older patients with muscle-invasive bladder cancer (MIBC) treated with definitive radiation therapy (RT) with or without chemotherapy (CHT) at a tertiary medical center. METHODS AND MATERIALS A retrospective study was conducted for older patients with MIBC who were ≥70 years old and underwent RT with or without CHT between 2000 and 2016. Overall survival (OS) was estimated using the Kaplan-Meier method. Disease-specific survival (DSS), cumulative incidence of progression, patterns of recurrence, and toxicities were examined. Univariate analyses were performed to identify variables associated with OS, DSS, and cumulative incidence of progression, using the Cox proportional hazards model. RESULTS A total of 84 patients underwent definitive RT with or without CHT. Of these, only 29% were deemed medically fit to undergo radical cystectomy, and the remainder were medically unfit or had surgically unresectable disease. Median age was 81 years. Sixty-one percent, 29%, and 11% had clinical stage II, III, and IV disease, respectively. Eighty-six percent had maximal transurethral resection of bladder tumor before RT. Seventy-three percent received CHT with RT, and 27% had RT alone. Median follow-up was 5.7 years. Median OS was 1.9 years. OS was 42% and 25%, and DSS was 64% and 54% at 3 and 5 years, respectively. On univariate analysis, medical fitness to undergo radical cystectomy, receipt of CHT, lower T stage, and maximal transurethral resection of bladder tumor were associated with better OS; lower T stage was associated with better DSS. The cumulative incidence of progression was 44% and 49% at 3 and 5 years, respectively. Late grade 3 genitourinary and gastrointestinal toxicity were 15% and 4%, respectively. None had grade 4 or 5 toxicity. CONCLUSIONS Older patients with MIBC referred for RT were often medically unfit or had a surgically unresectable tumor. In these medically compromised patients, definitive RT with or without CHT was well tolerated and yielded encouraging treatment outcomes.
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Affiliation(s)
| | - Cole R Kreofsky
- Department of Radiation Oncology, Bismarck Cancer Center, Bismarck, North Dakota
| | - Christopher S Choo
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jason Viehman
- Department of Biostatistics & Information, Mayo Clinic, Rochester, Minnesota
| | - W Scott Harmsen
- Department of Biostatistics & Information, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
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356
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Brassetti A, Mastroianni R, Simone G. Are we really seeking for equivalence?-The virtue of the robot is in technology. Transl Androl Urol 2020; 8:S502-S504. [PMID: 32042631 DOI: 10.21037/tau.2019.08.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aldo Brassetti
- Department of Urology, "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | | | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute of Rome, Rome, Italy
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357
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Gadzinski AJ, Psutka SP. Risk stratification metrics for bladder cancer: Comprehensive Geriatric Assessments. Urol Oncol 2020; 38:725-733. [PMID: 32037198 DOI: 10.1016/j.urolonc.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/26/2022]
Abstract
Despite advances in surgical technique and perioperative care pathways, complication rates following radical cystectomy for bladder cancer remain high and perioperative outcomes for elderly patients are suboptimal. Furthermore, subjective risk assessments of patients with bladder cancer, with a high prevalence of complex comorbidity burden and risk of frailty, may result in undertreatment of patients assumed to be poor operative candidates. A critical component of preoperative patient counseling and treatment selection is accurate and objective preoperative risk appraisal. Comprehensive Geriatric Assessments are multi-domain evaluations of the medical, functional, and psychosocial aspects of health designed specifically for use in elderly patients with the objective of identifying vulnerabilities that may be targeted with interventions for improvement. While currently recommended by multiple guideline bodies for use in the preoperative evaluation of elderly patients with bladder cancer there is a paucity of data describing their use in contemporary clinical practice. Herein, then, we will describe the components of a Comprehensive Geriatric Assessments and propose strategies for their integration into the preoperative surgical workflow.
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Affiliation(s)
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA.
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358
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Abe T. Editorial Comment from Dr Abe to Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort. Int J Urol 2020; 27:256-257. [PMID: 32022366 DOI: 10.1111/iju.14193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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359
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Nouhaud FX, Williams M, Yaxley W, Cho J, Perera M, Thangasamy I, Esler R, Coughlin G. Robot-assisted orthotopic “W” ileal neobladder in male patients: step-by-step video-illustrated technique and preliminary outcomes. J Robot Surg 2020; 14:739-744. [PMID: 32020512 DOI: 10.1007/s11701-020-01048-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- F X Nouhaud
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
| | - M Williams
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - W Yaxley
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - J Cho
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - M Perera
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - I Thangasamy
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - R Esler
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- The Wesley Urology Clinic, The Wesley Hospital, Brisbane, Australia
| | - G Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- The Wesley Urology Clinic, The Wesley Hospital, Brisbane, Australia
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360
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Zhou X, Zheng J, He P, Zhang J, Wang C, Zheng J, Li X, Lang L, Zhou Z, Chen Z. Refinement Surgical Technique, and Perioperative and Functional Outcomes in Patients With Robotic Intracorporeal Hautmann Orthotopic Neobladder. Urology 2020; 138:45-51. [PMID: 32006548 DOI: 10.1016/j.urology.2020.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/01/2020] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To illustrate our refinement technique for robotic intracorporeal orthotopic Hautmann neobladder with adherence to open surgical principles and evaluate perioperative and functional outcomes. PATIENTS AND METHODS Robot-assisted radical cystectomy with intracorporeal Hautmann orthotopic neobladder was performed by the same surgeon in 40 patients with bladder cancer from November 2017 to March 2019. Baseline demographics, pathologic data, 90-day complications, and functional outcomes at both 6 and 12 months were evaluated with questionnaire and urodynamic analysis. RESULTS Median follow-up was 14 months (range 4-20). Median operative time was 320 (230-500) minutes, and the estimated blood loss was 300 (100-2000) mL. No conversion to the open technique was reported. The overall 90-day complication rate was 45%, and the high-grade complication rate was only 10%. The daytime satisfactory continence rate was 90% at both 6 months (30 patients) and 12 months (20 patients), while the night-time satisfactory continence rate was 76.7% and 80.0% at 6 months and 12 months, respectively. One patient underwent clean intermittent catheterization. The cohort had minimal postvoid residual volume, normal compliance, and a mean capacity of 328.7 cm3 (range 170-500) at 6 months postoperatively. CONCLUSION Our preliminary data indicate that robotic intracorporeal Hautmann neobladder configuration is a feasible surgical technique and can achieve a low pressure and sufficient capacity for satisfactory early voiding patterns. Refinement of the stepwise process can effectively decrease the time of the operation. Long-term functional and oncological outcomes remain to be evaluated with longer follow-up and more cases.
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Affiliation(s)
- Xiaozhou Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Ji Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Peng He
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Jingqi Zhang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Cong Wang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Jun Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Xuemei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Lang Lang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Zhansong Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Zhiwen Chen
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China.
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Rose KM, Navaratnam AK, Faraj KS, Abdul-Muhsin HM, Syal A, Elias L, Moss AA, Eversman WG, Stone WM, Money SR, Davila VJ, Tyson MD, Castle EP. Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience. Urology 2020; 136:152-157. [DOI: 10.1016/j.urology.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
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362
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Moschovas MC, Chade DC, Arap MA, Sarkis AS, Nahas WC, Tanure LHR, Ebaid G, de Carvalho Fazoli AJ, Guglielmetti GB, Bistacco C, Cordeiro M, Afonso P, Sighinolfi MC, Rocco B, Coelho RF. Robotic-assisted radical cystectomy: the first multicentric Brazilian experience. J Robot Surg 2020; 14:703-708. [PMID: 32002803 DOI: 10.1007/s11701-020-01043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
The objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient's demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1-2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, ≥ pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery.
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Affiliation(s)
| | - Daher Cesar Chade
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Maurício Cordeiro
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Paulo Afonso
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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363
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Elsayed AS, Aldhaam NA, Nitsche L, Siam A, Jing Z, Hussein AA, Shigemura K, Fujisawa M, Guru KA. Robot‐assisted radical cystectomy: Review of surgical technique, and perioperative, oncological and functional outcomes. Int J Urol 2020; 27:194-205. [DOI: 10.1111/iju.14178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/04/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Ahmed S Elsayed
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Naif A Aldhaam
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Lindsay Nitsche
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Alat Siam
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Zhe Jing
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Ahmed A Hussein
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | | | - Masato Fujisawa
- Department of Urology Kobe University Hospital Kobe Hyogo Japan
| | - Khurshid A Guru
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
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364
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Khalil MI, Tourchi A, Langford BT, Bhandari NR, Payakachat N, Davis R, Safaan A, Raheem OA, Kamel MH. Early Postoperative Morbidity of Robotic Versus Open Radical Cystectomy in Obese Patients. J Endourol 2020; 34:461-468. [PMID: 31964189 DOI: 10.1089/end.2019.0560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare the 30-day postoperative complications of robotic radical cystectomy (RRC) vs open radical cystectomy (ORC) in obese patients (body mass index ≥30) with bladder cancer (BC). Methods: The National Surgical Quality Improvement Program database was queried to identify obese BC patients who underwent RRC or ORC between 2005 and 2016. Patient demographics, postoperative mortality rate, morbidity, operating time (OPTIME), length of stay (LOS), readmission, and reoperation rates were recorded and compared between the two groups. Each RRC patient was matched with three ORC patients using a propensity score approach. Results: Four hundred forty-two RRC patients were matched with 1326 ORC patients. No difference in early postoperative mortality rate between RRC and ORC (0.7% vs 1.3%, relative risk, RR [95% confidence interval CI]: 0.27 [0.07-1.02]). Compared with ORC, the RRC group showed shorter mean OPTIME (364.7 [standard deviation, SD = 133.4] vs 387.8 [SD = 129.7] minutes, p = 0.001) and mean LOS (7.1 [SD = 5.6] vs 10.6 [SD = 6.6] days, p < 0.001). Compared with ORC, the RR of developing the following events in RRC group was lower: 30-day postoperative any complication (45%), any wound occurrence (64%), blood transfusion (70%), superficial surgical-site infection (78%), and wound disruption (77%). There was no difference in the RR of any-cause readmission (RR [95% CI]: 0.77 [0.57-1.05]) and reoperation (RR [95% CI]: 0.48 [0.22-1.04]) between the two groups. Conclusions: The study revealed that RRC for obese BC patients is associated with shorter OPTIME, shorter LOS, and lower risk of early postoperative complications when compared with a matched group of patients who received ORC. In addition, no difference in early postoperative mortality rate between RRC and ORC was observed.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ali Tourchi
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brian T Langford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ahmed Safaan
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
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365
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Kanno T, Inoue T, Ito K, Okumura K, Yamada H, Kawakita M, Fujii M, Shimizu Y, Yatsuda J, Moroi S, Shichiri Y, Akao T, Sawada A, Kobayashi T, Ogawa O. Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort. Int J Urol 2020; 27:250-256. [PMID: 31944410 DOI: 10.1111/iju.14182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/17/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer in a Japanese multicenter cohort, and to explore the risk factors associated with recurrences due to tumor dissemination. METHOD Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. Multivariate analyses were carried out to identify the clinical parameters associated with overall recurrences together with specific recurrence types. Kaplan-Meier curves were created to elucidate time to recurrence and survival. RESULTS A total of 411 patients were included after the final analysis. Postoperative pathology was T2 or higher in 196 patients (48%), and lymph node metastasis was present in 46 patients (11%). The median follow-up period was 23 months, and the 2-year recurrence-free and cancer-specific survival rates were 71.0% and 84.7%, respectively. The recurrence sites involved distant metastasis in 75 patients (18%), local recurrence in 52 patients (13%) and urinary tract recurrence in eight patients (2%). When local recurrence at the cystectomy bed (28 patients; 7%) and abdominal recurrence including peritoneal carcinomatosis or port site recurrence (17 patients; 4%), which might be caused by tumor dissemination, were combined into a single group, prolonged surgical time was a significant risk factor, in addition to high pathological stage (T3-4 and/or positive lymph nodes), positive surgical margins, and variant histology by both univariate and multivariate analyses. CONCLUSIONS Our study findings suggest that recurrences after laparoscopic radical cystectomy might be caused by tumor dissemination, and attention should be paid to avoid prolonged surgical time in laparoscopic radical cystectomy.
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Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takahiro Inoue
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | | | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masato Fujii
- Department of Urology, Miyazaki University, Miyazaki, Japan
| | - Yosuke Shimizu
- Department of Urology, Nishikobe Medical Center, Hyogo, Japan
| | - Junji Yatsuda
- Department of Urology, Kumamoto University, Kumamoto, Japan
| | - Seiji Moroi
- Department of Urology, Hamamatsu Rosai Hospital, Shizuoka, Japan
| | | | - Toshiya Akao
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Atsuro Sawada
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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366
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Narayan VM, Seif MA, Lim AH, Li R, Matulay JT, Kukreja JB, Qiao W, Hwang H, Shah JB, Pisters L, Kamat AM, Dinney C, Navai N. Radical cystectomy in women: Impact of the robot-assisted versus open approach on surgical outcomes. Urol Oncol 2020; 38:247-254. [PMID: 31953001 DOI: 10.1016/j.urolonc.2019.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/10/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To perform a comparison of complications following open versus robot-assisted radical cystectomy (RC) among women who undergo the procedure. Studies comparing robotic to open RC have been mixed without a clear delineation of which patients benefit the most from one modality vs. the other, leading to continued debate. PATIENTS AND METHODS This was a retrospective study of women who underwent either open or robotic RC at the MD Anderson Cancer Center from 1/2014 to 6/2018. Co-morbidities, pathologic data, and complications were assessed with descriptive statistics, along with uni- and multivariable logistic regression. RESULTS 122 women underwent either open (n = 76) or robotic (n = 46) RC. Open RC was associated with greater intraoperative blood loss (median EBL 775 ml vs. 300 ml, P < 0.001). In both uni- and multivariable analyses, open RC was associated with a greater odds of intraoperative transfusion compared to robotic RC (odds ratio 6.49, 95% CI 2.85-14.78, P < 0.001). Women undergoing open RC were also at greater odds of receiving 4 or more units of packed red blood cells (odds ratio 5.46 (1.75-17.02), P = 0.003). Robotic RC conferred a higher median lymph node yield (27 vs. 20 nodes, P, <0.001) and operative times (median 513 min vs. 391.5 min, P < 0.001). There were no differences in margin positivity, length of stay, or readmission rates at 30 and 90 days. CONCLUSIONS Robotic RC was associated with a significantly lower risk of transfusion and EBL, and a higher median lymph node yield and operative time. Unique anatomic considerations may in part be responsible for these findings.
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Affiliation(s)
- Vikram M Narayan
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mohamed A Seif
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy H Lim
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roger Li
- Department of Urology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Justin T Matulay
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Janet B Kukreja
- Urology Division, Department of Surgery, University of Colorado School of Medicine, Denver, CO
| | - Wei Qiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hyunsoo Hwang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay B Shah
- Department of Urology, Stanford University, Stanford, CA
| | - Louis Pisters
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish M Kamat
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Colin Dinney
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neema Navai
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
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367
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Bertolo R, Garisto J, Bove P, Kaouk J. AUTHOR REPLY. Urology 2020; 129:98. [PMID: 31235009 DOI: 10.1016/j.urology.2018.11.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/30/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Riccardo Bertolo
- San Carlo di Nancy Hospital, Rome, Italy; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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368
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369
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Pessoa R, Navai N, Kukreja JB. EDITORIAL COMMENT. Urology 2020; 135:64-65. [PMID: 31895682 DOI: 10.1016/j.urology.2019.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Neema Navai
- University of Texas MD Anderson Cancer Center, Houston, TX
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370
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Minimally invasive vs open radical cystectomy in patients with bladder cancer: A systematic review and meta-analysis of randomized controlled trials. Eur J Surg Oncol 2020; 46:44-52. [DOI: 10.1016/j.ejso.2019.09.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/16/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022] Open
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371
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Nagasubramanian S. Open versus robotic radical cystectomy: Results from the 3-year follow-up of the RAZOR trial. Indian J Urol 2020; 36:225-226. [PMID: 33082642 PMCID: PMC7531386 DOI: 10.4103/iju.iju_94_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022] Open
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372
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Liu Z, Meng Y, Li S, Yu W, Jin J. Perioperative recovery in different urinary reconstruction approaches of radical cystectomy: Are the advantages of laparoscopy consistent? J Minim Access Surg 2020; 16:390-398. [PMID: 31929226 PMCID: PMC7597872 DOI: 10.4103/jmas.jmas_227_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Radical cystectomy (RC) has complicated surgical procedures and various ways of urinary reconstruction. Aims: The aim of this study is to investigate whether the advantages of laparoscopy over open surgery were consistent in the perioperative recovery of different methods of urinary diversion after RC in the general and the elderly (>65 years) population. Settings and Design: A retrospective study reviewed 452 (elderly 261) patients who received RC from the year 2005–2012. Subjects and Methods: Of all, 88 patients underwent laparoscopic RC (LRC) and 364 patients underwent open RC (ORC). There were 325 patients received ileal conduit (IC), whereas 127 patients received cutaneous ureterostomy (CU). Statistical Analysis Used: We used different statistical methods (t-test, Chi-square, etc.) to compare variables outcomes. Results: For IC urinary diversion, the general patients undergoing LRC had less intra-operative blood loss (566.5 vs. 1320.3 ml, P < 0.001), lower blood transfusion rate (11.4 vs. 34.1%, P < 0.001), shorter gastrointestinal recovery time (5.7 vs. 6.7 days, P = 0.002) and shorter length of hospital stay (LOS) (21.7 vs. 26.0 days, P = 0.003) than patients receiving ORC. Similar trends were observed in older patients. For CU urinary diversion, the general and the elderly patients receiving LRC had a shorter mean time to gastrointestinal recovery (P = 0.017, P < 0.001, respectively) than patients receiving ORC. No differences were found between LRC and ORC in intra-operative blood loss, allogeneic blood transfusion rate and LOS. Conclusions: In the general and the elderly population, laparoscopic approach could result in more rapid rehabilitation for RC patients, especially in the IC patients.
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Affiliation(s)
- Zhenhua Liu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
| | - Yisen Meng
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
| | - Shaobo Li
- Department of Pathology, School of Basic Medicine, Fudan University, Shanghai, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
| | - Jie Jin
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
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373
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Solanki AA, Liauw SL. The perils of using registry data to compare the survival and cost of radical cystectomy and trimodality therapy in bladder cancer. Transl Androl Urol 2019; 8:S533-S537. [PMID: 32042640 DOI: 10.21037/tau.2019.12.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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374
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Lin FC, Medendorp A, Van Kuiken M, Mills SA, Tarnay CM. Vaginal Dehiscence and Evisceration After Robotic-assisted Radical Cystectomy: A Case Series and Review of the Literature. Urology 2019; 134:90-96. [DOI: 10.1016/j.urology.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
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375
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Albisinni S, Veccia A, Aoun F, Diamand R, Esperto F, Porpiglia F, Roumeguère T, De Nunzio C. A systematic review and meta-analysis comparing the outcomes of open and robotic assisted radical cystectomy. MINERVA UROL NEFROL 2019; 71:553-568. [DOI: 10.23736/s0393-2249.19.03546-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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376
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Brassetti A, Tuderti G, Anceschi U, Ferriero M, Guaglianone S, Gallucci M, Simone G. Combined reporting of surgical quality, cancer control and functional outcomes of robot-assisted radical cystectomy with intracorporeal orthotopic neobladder into a novel trifecta. MINERVA UROL NEFROL 2019; 71:590-596. [DOI: 10.23736/s0393-2249.19.03566-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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377
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Clinton TN, Wiseman M, Walasek A, Pietzak E. Commentary: underutilization of curative-intent therapy for patients with muscle-invasive bladder cancer in Sweden mimics the United States. Transl Androl Urol 2019; 8:S542-S545. [PMID: 32042642 PMCID: PMC6989840 DOI: 10.21037/tau.2019.12.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Timothy N Clinton
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michal Wiseman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aleksandra Walasek
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eugene Pietzak
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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378
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Sighinolfi MC, Micali S, Eissa A, Picozzi SCM, Puliatti S, Rocco B. Robotic assisted radical cystectomy: insights on long term oncological outcomes from the International Robotic Cystectomy Consortium. Transl Androl Urol 2019; 8:S521-S523. [PMID: 32042637 PMCID: PMC6989854 DOI: 10.21037/tau.2019.12.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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379
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Robot Assisted Cystectomy With Holmium Laser Debridement for Osteomyelitis of the Pubic Symphysis With Urinary Fistula. Urology 2019; 134:124-134. [DOI: 10.1016/j.urology.2019.08.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
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380
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Robot Assisted Radical Cystectomy vs Open Radical Cystectomy: Over 10 years of the Mayo Clinic Experience. Urol Oncol 2019; 37:862-869. [DOI: 10.1016/j.urolonc.2019.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 01/22/2023]
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381
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Yamashita R, Nakamura M, Notsu A, Hashizume A, Shinsaka H, Matsuzazki M, Niwakawa M. The occurrence of high-grade complications after radical cystectomy worsens oncological outcomes in patients with bladder cancer. Int Urol Nephrol 2019; 52:475-480. [PMID: 31758383 DOI: 10.1007/s11255-019-02341-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Reports frequently describe the worsening of oncologic outcome in patients who developed high-grade complications after curative surgery for esophageal, gastric, and breast cancers. We investigated the extent of this correlation in patients with bladder cancer after radical cystectomy (RC). METHODS During 2002-2017, we performed 326 RC and urinary diversion procedures and collected data regarding complications in these patients within 90 days postoperatively. We evaluated the severity of complications based on the modified Clavien-Dindo classification (grades 0-5). Grade ≥ 3 complications were considered high grade. After adjusting for confounding factors using a Cox regression model, we calculated the hazard ratios (HRs) for high-grade complications associated with recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS During a median follow-up period of 61 months, 38 patients (12%) developed high-grade complications (grade ≥ 3). The main causes (76%) of high-grade complications were gastrointestinal and infection problems. The RFS and CSS differed significantly between patients with high-grade complications and those without complications. After adjusting for confounding factors in the multivariate analysis, high-grade complications remained a significant risk factor for both RFS [HR 2.11; 95% confidence interval (CI) 1.07-4.15, p = 0.030] and CSS (HR 2.74; 95% CI 1.05-7.14, p = 0.039). CONCLUSIONS High-grade complications after RC led to worse RFS and CSS outcomes, similar to those observed in patients with other cancers. A large-scale study is needed to further verify these findings, and discussions of knowledge and experiences are required to reduce the incidence of postoperative high-grade complications.
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Affiliation(s)
- Ryo Yamashita
- Division of Urology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, Japan.
| | - Masafumi Nakamura
- Division of Urology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan
| | - Akihito Hashizume
- Division of Urology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, Japan
| | - Hideo Shinsaka
- Division of Urology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, Japan
| | - Masato Matsuzazki
- Division of Urology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, Japan
| | - Masashi Niwakawa
- Division of Urology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, Japan
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382
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Evolving Concepts in the Evaluation and Management of Bladder Cancer in Elderly Men. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-00301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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383
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Long-term Oncological Outcomes from an Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL). Eur Urol 2019; 77:110-118. [PMID: 31740072 DOI: 10.1016/j.eururo.2019.10.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The long-term oncological outcomes of laparoscopic (LRC) and robotic-assisted radical cystectomy (RARC) are still maturing compared with open radical cystectomy (ORC). OBJECTIVE To evaluate the 5-yr oncological outcomes of patients recruited into the randomised trial of Open, Laparoscopic and Robot Assisted Cystectomy (CORAL) and extracorporeal urinary diversion. DESIGN, SETTING, AND PARTICIPANTS A review of prospectively maintained database of 60 patients with muscle-invasive bladder cancer (MIBC) or high-risk nonmuscle-invasive bladder cancer (HRNMIBC) who were previously randomised in the CORAL trial to receive ORC, RARC, or LRC. This trial was designed to compare the perioperative and early oncological outcomes of these techniques. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcomes of interest included 5-yr recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves were used to plot the recurrence and survival data. The curves between RFS, CSS, and OS were compared using the log-rank test. A two-sided p value <0.05 was considered significant. Results were analysed on the basis of intention to treat. RESULTS AND LIMITATIONS A total of 60 patients with either MIBC (n=38) or HRNMIBC (n=21) were randomised in the CORAL trial to receive ORC, RARC, or LRC. The 5-yr RFS was 60%, 58%, and 71%; 5-yr CSS was 64%, 68%, and 69%; and 5-yr OS was 55%, 65%, and 61% for ORC, RARC, and LRC, respectively. There was no significant difference in RFS, CSS, and OS between the three surgical arms. The principal limitation is the small sample size. CONCLUSIONS There was no difference in 5-yr RFS, CSS, and OS rates of patients who underwent ORC, RARC, and LRC for management of bladder cancer. Minimally invasive techniques achieved equivalent oncological outcomes to the gold standard of ORC. However, the study was based at a single institution with a small sample size. PATIENT SUMMARY Patients who agreed to participate in the randomised trial of either open, laparoscopic, or robotic-assisted radical cystectomy for bladder cancer did not have different cancer outcomes at 5yr.
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384
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Lenfant L, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, de La Taille A, Roumiguie M, Lesourd M, Taksin L, Misraï V, Granger B, Ploussard G, Vaessen C, Verhoest G, Rouprêt M. Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study. World J Urol 2019; 38:1951-1958. [PMID: 31720765 DOI: 10.1007/s00345-019-02998-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted radical cystectomy (RARC) has been shown to be non-inferior to open radical cystectomy (ORC) for the treatment of bladder cancer (BC). However, most data on RARC come from high-volume surgeons at high-volume centers. The objective of the study was to compare perioperative and mid-term oncologic outcomes of RARC versus ORC in a real-life cohort of patients treated by surgeons starting their experience with RARC. MATERIALS AND METHODS Data were prospectively collected from consecutive patients undergoing RARC and ORC at five referral Centers between 2010 and 2016 by five surgeons (one per center) with no prior experience in RARC. Patients with high-risk non-muscle-invasive or organ-confined muscle-invasive (T2N0M0) bladder cancer were considered for RARC. The main study endpoints were perioperative outcomes, postoperative surgical complications, and mid-term oncologic outcomes. RESULTS Overall, 124 and 118 patients underwent RARC and ORC, respectively. Baseline patients' and tumors' characteristics were comparable between the two groups. Yet, the proportion of patients receiving neoadjuvant chemotherapy was significantly higher in the RARC cohort. Median operative time was significantly higher, while median EBL, LOH, and transfusion rates were significantly lower after RARC. Median number of lymph nodes removed was significantly higher after RARC. All other histopathological outcomes, as well as the rate of early (< 30 days) and late postoperative complications, were comparable to ORC. At a median follow-up of 2 years, 29 (23%) and 41 (35%) patients developed disease recurrence (p = 0.05), while 20 (16%) and 37 (31%) died of bladder cancer (p = 0.005) after RARC and ORC, respectively. CONCLUSIONS With proper patient selection, RARC was non-inferior to ORC throughout the surgeons' learning phase. Yet, the observed differences in oncologic outcomes suggest selection bias toward adoption of RARC for patients with more favorable disease characteristics.
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Affiliation(s)
- Louis Lenfant
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Riccardo Campi
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Jérôme Parra
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Vivien Graffeille
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Dimitri Vordos
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Alexandre de La Taille
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Mathieu Roumiguie
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Marine Lesourd
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Lionel Taksin
- Hôpital privé d'Antony, 1 rue Velpeau, 92160, Antony, France
| | - Vincent Misraï
- Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France
| | - Benjamin Granger
- Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Sorbonne, Paris, France
| | | | - Christophe Vaessen
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gregory Verhoest
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Morgan Rouprêt
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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385
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Morii Y, Osawa T, Suzuki T, Shinohara N, Harabayashi T, Ishikawa T, Tanikawa T, Yamashina H, Ogasawara K. Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs. BMC Urol 2019; 19:110. [PMID: 31703573 PMCID: PMC6842244 DOI: 10.1186/s12894-019-0533-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 10/06/2019] [Indexed: 01/25/2023] Open
Abstract
Background Robot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs. Methods A systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs. Results We identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1–70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases. Conclusions The results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.
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Affiliation(s)
- Yasuhiro Morii
- Graduate school of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery Graduate School of Medicine, Hokkaido University, N14, W5, KitaKu, Sapporo, Hokkaido, Japan
| | - Teppei Suzuki
- Hokkaido University of Education, Art, and Sports Business, Sapporo, Hokkaido, Japan.,Faculty of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery Graduate School of Medicine, Hokkaido University, N14, W5, KitaKu, Sapporo, Hokkaido, Japan
| | - Toru Harabayashi
- Department of Urology, Hokkaido Cancer Center, 3-54, Kikusui 4-2, Shiroishiku, Sapporo, Hokkaido, Japan
| | - Tomoki Ishikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan.,Institute for Health Economics and Policy, No.11 Toyo-kaiji Bldg, 1-5-11, Nishi-Shimbashi,Minato-ku, Tokyo, Japan
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University of Science, 7-Jo 15-4-1 Maeda, Teine, Sapporo, Hokkaido, Japan
| | - Hiroko Yamashina
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan.
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386
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A Population-based Study of Ureteroenteric Strictures After Open and Robot-assisted Radical Cystectomy. Urology 2019; 135:57-65. [PMID: 31618656 DOI: 10.1016/j.urology.2019.07.054] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.
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387
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Tae JH, Pyun JH, Shim JS, Cho S, Kang SG, Ko YH, Cheon J, Lee JG, Kang SH. Oncological and functional outcomes of robot-assisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve? Investig Clin Urol 2019; 60:463-471. [PMID: 31692995 PMCID: PMC6821988 DOI: 10.4111/icu.2019.60.6.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/04/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.
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Affiliation(s)
- Jong Hyun Tae
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Cheon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
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388
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Zamboni S, Soria F, Mathieu R, Xylinas E, Abufaraj M, D Andrea D, Tan WS, Kelly JD, Simone G, Gallucci M, Meraney A, Krishna S, Konety BR, Antonelli A, Simeone C, Baumeister P, Mattei A, Briganti A, Gallina A, Montorsi F, Rink M, Aziz A, Karakiewicz PI, Rouprêt M, Koupparis A, Scherr DS, Ploussard G, Sooriakumaran P, Shariat SF, Moschini M. Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration. BJU Int 2019; 124:656-664. [PMID: 31055865 DOI: 10.1111/bju.14791] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. MATERIALS AND METHODS We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. RESULTS Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. CONCLUSION The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
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Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Rennes University Hospital, Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - David D Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Simone
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Alessandro Antonelli
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | | | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Atiqullah Aziz
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Morgan Rouprêt
- GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | -
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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389
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Shi H, Li J, Li K, Yang X, Zhu Z, Tian D. Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis. J Int Med Res 2019; 47:4604-4618. [PMID: 31638461 PMCID: PMC6997785 DOI: 10.1177/0300060519864806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background We performed a systematic review and meta-analysis to evaluate the efficacy and safety of minimally invasive radical cystectomy (MIRC) versus open radical cystectomy (ORC) for bladder cancer. Methods We searched the EMBASE and MEDLINE databases to identify randomized controlled trials (RCTs) of MIRC versus ORC in the treatment of bladder cancer. Results Eight articles describing nine RCTs (803 patients) were analyzed. No significant differences were found between MIRC and ORC in two oncologic outcomes: the recurrence rate and mortality. Additionally, no significant differences were found in three pathologic outcomes: lymph node yield, positive lymph nodes, and positive surgical margins. With respect to perioperative outcomes, however, MIRC showed a significantly longer operating time, less estimated blood loss, lower blood transfusion rate, shorter time to regular diet, and shorter length of hospital stay than ORC. The incidence of complications was similar between the two techniques. We found no statistically significant differences in the above outcomes between robot-assisted radical cystectomy and ORC or between laparoscopic radical cystectomy and ORC with the exception of the complication rate. Conclusions MIRC is an effective and safe surgical approach in the treatment of bladder cancer. However, a large-scale multicenter RCT is needed to confirm these findings.
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Affiliation(s)
- Hongbin Shi
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiangsong Li
- Department of Urology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Kui Li
- Department of Urology Surgery, The People's Hospital of Yucheng, Yucheng, China
| | - Xiaobo Yang
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zaisheng Zhu
- Department of Urology, Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Daxue Tian
- Department of Urology, Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, China
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390
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Chen J, Djaladat H, Schuckman AK, Aron M, Desai M, Gill IS, Clifford TG, Ghodoussipour S, Miranda G, Cai J, Daneshmand S. Surgical approach as a determinant factor of clinical outcome following radical cystectomy: Does Enhanced Recovery After Surgery (ERAS) level the playing field? Urol Oncol 2019; 37:765-773. [DOI: 10.1016/j.urolonc.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023]
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391
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Kaouk J, Garisto J, Eltemamy M, Bertolo R. Step-by-step technique for single-port robot-assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci ® SP™ surgical system. BJU Int 2019; 124:707-712. [PMID: 30868722 DOI: 10.1111/bju.14744] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To describe a step-by-step technique for robot-assisted radical cystectomy (RARC) with pelvic lymph node dissection (PLND) performed using the da Vinci® SP™ surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). PATIENTS AND METHODS Four consecutive patients diagnosed with urothelial carcinoma of the bladder were counselled for RARC with PLND and ileal conduit urinary diversion performed using the da Vinci SP surgical system. A 3-cm midline incision was made 5-cm above the umbilicus. Dissection was performed to access the abdominal cavity. Insertion of the GelPOINT® advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) with the SP Cannula was performed through the incision made. A 12-mm AirSeal® (SurgiQuest Inc., Milfort, CT, USA) port for the assistant was placed on the pre-marked stoma site, where an ileal conduit urinary diversion was desired. Demographics and perioperative outcomes were collected under Institutional Review Board approval (IRB 13-780). The surgeries were performed by reproducing the steps of the institutional approach for RARC performed with the multi-arm robotic platform. RESULTS The surgeries were successfully completed. There was neither conversion to standard multi-arm robotic or open approaches nor the need for additional port placement. The mean (range) operative time was 454 (420-496) min. Blood loss averaged 312 mL. No transfusions were required and no intraoperative complications occurred. All patients had negative surgical margins. All patients were discharged on postoperative day 5. CONCLUSION From our preliminary experience, RARC with PLND and ileal conduit urinary diversion is feasible and safe using the da Vinci SP surgical system. Further comparative studies with open and multi-arm robotic approaches are warranted.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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392
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Venkatramani V, Parekh DJ. Editorial Comment on: Does the Use of the Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open to Robotic Counterparts by Tzelves et al. (From: Tzelves L, Skolarikos A, Mourmouris P, et al. J Endourol 2019;33:971-984; DOI: 10.1089/end.2019.0226). J Endourol 2019; 33:985. [PMID: 31544492 DOI: 10.1089/end.2019.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Coral Gables, Florida
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Coral Gables, Florida
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393
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Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup. J Urol 2019; 203:522-529. [PMID: 31549935 DOI: 10.1097/ju.0000000000000565] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The RAZOR (Randomized Open versus Robotic Cystectomy) trial revealed noninferior 2-year progression-free survival for robotic radical cystectomy. This update was performed with extended followup for 3 years to determine potential differences between the approaches. We also report 3-year overall survival and sought to identify factors predicting recurrence, and progression-free and overall survival. MATERIALS AND METHODS We analyzed the per protocol population of 302 patients from the RAZOR study. Cumulative recurrence was estimated using nonbladder cancer death as the competing risk event and the Gray test was applied to assess significance in differences. Progression-free survival and overall survival were estimated by the Kaplan-Meier method and compared with the log rank test. Predictors of outcomes were determined by Cox proportional hazard analysis. RESULTS Estimated progression-free survival at 36 months was 68.4% (95% CI 60.1-75.3) and 65.4% (95% CI 56.8-72.7) in the robotic and open groups, respectively (p=0.600). At 36 months overall survival was 73.9% (95% CI 65.5-80.5) and 68.5% (95% CI 59.8-75.7) in the robotic and open groups, respectively (p=0.334). There was no significant difference in the cumulative incidence rates of recurrence (p=0.802). Patient age greater than 70 years, poor performance status and major complications were significant predictors of 36-month progression-free survival. Stage and positive margins were significant predictors of recurrence, and progression-free and overall survival. Surgical approach was not a significant predictor of any outcome. CONCLUSIONS This analysis showed no difference in recurrence, 3-year progression-free survival or 3-year overall survival for robotic vs open radical cystectomy. It provides important prospective data on the oncologic efficacy of robotic radical cystectomy and high level data for patient counseling.
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394
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Taylor J, Meng X, Renson A, Smith AB, Wysock JS, Taneja SS, Huang WC, Bjurlin MA. Different models for prediction of radical cystectomy postoperative complications and care pathways. Ther Adv Urol 2019; 11:1756287219875587. [PMID: 31565072 PMCID: PMC6755632 DOI: 10.1177/1756287219875587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Radical cystectomy for bladder cancer has one of the highest rates of
morbidity among urologic surgery, but the ability to predict postoperative
complications remains poor. Our study objective was to create machine
learning models to predict complications and factors leading to extended
length of hospital stay and discharge to a higher level of care after
radical cystectomy. Methods: Using the American College of Surgeons National Surgical Quality Improvement
Program, peri-operative adverse outcome variables for patients undergoing
elective radical cystectomy for bladder cancer from 2005 to 2016 were
extracted. Variables assessed include occurrence of minor, infectious,
serious, or any adverse events, extended length of hospital stay, and
discharge to higher-level care. To develop predictive models of radical
cystectomy complications, we fit generalized additive model (GAM), least
absolute shrinkage and selection operator (LASSO) logistic, neural network,
and random forest models to training data using various candidate predictor
variables. Each model was evaluated on the test data using receiver
operating characteristic curves. Results: A total of 7557 patients were identified who met the inclusion criteria, and
2221 complications occurred. LASSO logistic models demonstrated the highest
area under curve for predicting any complications (0.63), discharge to a
higher level of care (0.75), extended length of stay (0.68), and infectious
(0.62) adverse events. This was comparable with random forest in predicting
minor (0.60) and serious (0.63) adverse events. Conclusions: Our models perform modestly in predicting radical cystectomy complications,
highlighting both the complex cystectomy process and the limitations of
large healthcare datasets. Identifying the most important variable leading
to each type of adverse event may allow for further strategies to model
cystectomy complications and target optimization of modifiable variables
pre-operative to reduce postoperative adverse events.
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Affiliation(s)
- Jacob Taylor
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - Xiaosong Meng
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - Audrey Renson
- Department of Clinical Research, NYU Langone
Hospital, Brooklyn, NY, USA
| | - Angela B. Smith
- Department of Urology, Lineberger Comprehensive
Cancer Center, University of North Carolina at Chapel Hill, NC, USA
| | - James S. Wysock
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - Samir S. Taneja
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - William C. Huang
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
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395
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Van Hemelrijck M, Sparano F, Josephs D, Sprangers M, Cottone F, Efficace F. Patient-reported outcomes in randomised clinical trials of bladder cancer: an updated systematic review. BMC Urol 2019; 19:86. [PMID: 31521149 PMCID: PMC6744649 DOI: 10.1186/s12894-019-0518-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/02/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite international recommendations of including patient-reported outcomes (PROs) in randomised clinical trials (RCTs), a 2014 review concluded that few RCTs of bladder cancer (BC) report PRO as an outcome. We therefore aimed to update the 2014 review to synthesise current evidence-based knowledge of PROs from RCTs in BC. A secondary objective was to examine whether quality of PRO reporting has improved over time and to provide evidence-based recommendations for future studies in this area. METHODS We conducted a systematic literature search using PubMed/Medline, from April 2014 until June 2018. We included the RCTs identified in the previous review as well as newly published RCTs. Studies were evaluated using a predefined electronic-data extraction form that included information on basic trial demographics, clinical and PRO characteristics and standards of PRO reporting based on recommendation from the International Society of Quality of Life Research. RESULTS Since April 2014 only eight new RCTs for BC included PROs as a secondary outcome. In terms of methodology, only the proportion of RCTs documenting the extent of missing PRO data (75% vs 11.1%, p = 0.03) and the identification of PROs in trial protocols (50% vs 0%, p = 0.015) improved. Statistical approaches for dealing with missing data were not reported in most new studies (75%). CONCLUSION Little improvement into the uptake and assessment of PRO as an outcome in RCTs for BC has been made during recent years. Given the increase in (immunotherapy) drug trials with a potential for severe adverse events, there is urgent need to adopt the recommendations and standards available for PRO use in bladder cancer RCTs.
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Affiliation(s)
- Mieke Van Hemelrijck
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, SE1 9RT UK
| | - Francesco Sparano
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease (GIMEMA), Rome, Italy
| | - Debra Josephs
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, SE1 9RT UK
- Guy’s and St Thomas’ NHS Foundation Trust, Medical Oncology, London, UK
| | - Mirjam Sprangers
- Department of Medical Psychology, Location AMC, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease (GIMEMA), Rome, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease (GIMEMA), Rome, Italy
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396
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Michels CTJ, Wijburg CJ, Abma IL, Witjes JA, Grutters JPC, Rovers MM. Translation and validation of two disease-specific patient-reported outcome measures (Bladder Cancer Index and FACT-Bl-Cys) in Dutch bladder cancer patients. J Patient Rep Outcomes 2019; 3:62. [PMID: 31522328 PMCID: PMC6745039 DOI: 10.1186/s41687-019-0149-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Bladder Cancer Index (BCI) and Functional Assessment of Cancer Therapy-Bladder-Cystectomy (FACT-Bl-Cys) were developed to measure disease-specific health-related quality of life (HRQOL) in bladder cancer patients and patients treated with radical cystectomy, respectively. Both patient-reported outcome measures (PROMs) are frequently used in clinical practice, but are not yet validated according to the COSMIN criteria and not yet available in Dutch. Therefore, the aim of this study was to translate the BCI and FACT-Bl-Cys into Dutch and to evaluate their measurement properties according to the COSMIN criteria. METHODS The BCI and FACT-Bl-Cys were translated into Dutch using a forward-backward method, and subsequently administered at baseline (pre-operatively) and 3 months post-operatively in bladder cancer patients who received a radical cystectomy. Validity (content and construct), reliability (internal consistency, test-retest reliability, and measurement error), floor and ceiling effects, and responsiveness were assessed according to the COSMIN criteria. RESULTS Forward-backward translation encountered no particular linguistic problems. In total 260 patients completed the baseline measurement, while 182 patients completed the three-month measurement. Only a ceiling effect was identified for the BCI. Hypotheses testing for construct validity was satisfying, as 67% and 92% of the hypothesized correlations were confirmed. Structural validity was moderate for both measures, as confirmatory factor analyses showed limited fit. Reliability of both PROMs was good. The intraclass correlation coefficient (ICC) of the BCI domains ranged from 0.47 to 0.93, minimal value of Cronbach's α was 0.70, smallest detectable change on group level (SDC group) ranged from 1.9 to 8.6. The ICC of the FACT-Bl-Cys domains ranged from 0.43 to 0.83, minimal value of Cronbach's α was 0.77, SDC group was around 1. Only the FACT-Bl-Cys total score was found to be responsive to changes in generic quality of life. CONCLUSIONS The Dutch versions of the BCI and FACT-Bl-Cys were shown to be reliable and have good content validity. Structural validity was limited for both measures. Only the FACT-Bl-Cys total score was responsive to changes in generic HRQOL. Despite some limitations, both PROMs seem suitable for use in clinical practice and research.
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Affiliation(s)
- Charlotte T. J. Michels
- Department of Urology, Rijnstate Hospital, Arnhem, Netherlands
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carl J. Wijburg
- Department of Urology, Rijnstate Hospital, Arnhem, Netherlands
| | - Inger L. Abma
- IQ healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Janneke P. C. Grutters
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maroeska M. Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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397
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Honore M, Roberts MJ, Morton A, Teloken PE, Navaratnam A, Coughlin GD. Outcomes and learning curve for robotic‐assisted radical cystectomy: an Australian experience. ANZ J Surg 2019; 89:1593-1598. [DOI: 10.1111/ans.15413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/10/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew Honore
- Department of UrologyRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- Faculty of MedicineThe University of Queensland Brisbane Queensland Australia
| | - Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- Faculty of MedicineThe University of Queensland Brisbane Queensland Australia
| | - Andrew Morton
- Department of UrologyRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Patrick E. Teloken
- Department of UrologyRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Anojan Navaratnam
- Department of UrologyRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
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398
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Cacciamani GE, De Marco V, Sebben M, Rizzetto R, Cerruto MA, Porcaro AB, Gill IS, Artibani W. Robot-assisted Vescica Ileale Padovana: A New Technique for Intracorporeal Bladder Replacement Reproducing Open Surgical Principles. Eur Urol 2019; 76:381-390. [DOI: 10.1016/j.eururo.2018.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
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399
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400
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Mannas MP, Lee T, Forbes CM, Hong T, Bisaillon A, Gleave ME, So AI, Mayson K, Black PC. Predicting complications following radical cystectomy with the ACS NSQIP universal surgical risk calculator. World J Urol 2019; 38:1215-1220. [PMID: 31456016 DOI: 10.1007/s00345-019-02915-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/17/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Radical cystectomy (RC) is a challenging procedure with significant morbidity, though remains the standard of care treatment for many patients with bladder cancer. There has been debate regarding the utility of universal risk calculators to aid in point-of-care prediction of complications in individual patients preoperatively. We retrospectively evaluated the predictive value of the ACS NSQIP universal surgical risk calculator in our patients who underwent RC. METHODS A prospective cohort of patients undergoing RC was retrospectively reviewed between October 2014 and August 2017. Only patients who underwent a RC for genitourinary cancer without significant deviation from NSQIP surgery codes 51590, 51595, and 51596 (n = 29) were included. The accuracy of the risk calculator was assessed by ROC AUC and Brier scores for both NSQIP and Clavien-Dindo defined complications. Additionally, each NSQIP risk factor was individually assessed for association with postoperative complications. RESULTS 223 patients who underwent open or robotic RC (n = 18) were included for analysis. Determined by AUC C-stat and Brier scores, prediction was good for cardiac complications (0.80 and 0.021), fair for pneumonia (0.75 and 0.017), poor for UTI (0.64 and 0.078), 30-day mortality (0.62 and 0.013), any complication (0.60 and 0.19) and serious complication (0.60 and 0.17). There was a significant discordance between the rate of NSQIP predicted vs. Clavien-Dindo observed any and serious complications: 28.8% vs. 67.3%, and 25.3% vs. 11.7%, respectively. CONCLUSION The NSQIP universal surgical risk calculator did not perform with enough accuracy to consider adoption into clinical practice.
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Affiliation(s)
- Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada
| | - Connor M Forbes
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada
| | - Tracey Hong
- Operations Director, Surgery, Vancouver General Hospital, Vancouver, Canada
| | - Andrea Bisaillon
- Clinical Quality and Patient Safety Department, Vancouver General Hospital, Vancouver, Canada
| | - Martin E Gleave
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Kelly Mayson
- Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada.
- Vancouver Prostate Centre, Vancouver, BC, Canada.
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