1
|
Oswald D, Herrmann TRW, Netsch C, Becker B, Hatiboglu G, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Herrmann J, Gross AJ, Pallauf M, Deininger S, Ramesmayer C, Peters J, Lusuardi L. [Urinary diversion in old patients (80+ years)]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:795-803. [PMID: 39012493 PMCID: PMC11282126 DOI: 10.1007/s00120-024-02384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/17/2024]
Abstract
With increasing life expectancy there is also an increased need for the management of older (≥ 80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.
Collapse
Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - T R W Herrmann
- Urologie, Abteilung für Urologie, Kantonsspital Frauenfeld, Frauenfeld, Schweiz
| | - C Netsch
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - B Becker
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Asklepios Klinik, Barmbek, Hamburg, Deutschland
| | | | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologie, Kantonsspital Münsterlingen, Münsterlingen, Schweiz
- Abteilung für Urologie, Uniklinikum Ulm, Abteilung für Urologie und Kinderurologie, Ulm, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - J Herrmann
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
- Klinik für Urologie und Urochirurgie, Universitätsklinkum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - A J Gross
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Pallauf
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - C Ramesmayer
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - J Peters
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| |
Collapse
|
2
|
Bizzarri FP, Scarciglia E, Russo P, Marino F, Presutti S, Moosavi SK, Ragonese M, Campetella M, Gandi C, Totaro A, Palermo G, Sacco E, Racioppi M. Elderly and bladder cancer: The role of radical cystectomy and orthotopic urinary diversion. Urologia 2024; 91:500-504. [PMID: 38551153 PMCID: PMC11308345 DOI: 10.1177/03915603241240644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/26/2024] [Indexed: 08/07/2024]
Abstract
The incidence of bladder cancer (BC) depends on advancing age and other risk factors, significantly impacting on surgical, functional and oncological outcomes. Radical cystectomy (RC) with urinary diversion is the gold standard therapy for muscle invasive bladder cancer; however, it remains a complex surgery and requires careful analysis of risk factors in order to potentially decrease post-surgical complication rates. Age in surgery is a limiting factor that can modify surgical and oncological outcomes, and is correlated with a high rate of post-dimssion hospital readmissions. The reconstruction of the bladder with the intestine represents a crucial point of radical cystectomy and the urinary derivation (UD) is at the center of many debates. A non-continent UD seems to be the best choice in elderly patients (>75 years old), while orthotopic neobladder (ON) is poorly practiced. We reviewed the literature to identify studies reporting outcomes, complications, patient- selection criteria, and quality-of-life data on elderly patients, who underwent ON following radical cystectomy. Reviewing the literature there is no clear evidence on the use of age as an exclusion criterion. Certainly, the elderly patient with multiple comorbidities is not eligible for ON, preferring other UD or rescue therapies. A careful preoperative selection of elderly patients could greatly improve clinical, surgical and oncological outcomes, giving the chance to selected patients to receive an ON.
Collapse
Affiliation(s)
- Francesco Pio Bizzarri
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Eros Scarciglia
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pierluigi Russo
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Marino
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Simona Presutti
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Seyed Koosha Moosavi
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mauro Ragonese
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Campetella
- Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy
| | - Carlo Gandi
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Angelo Totaro
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Palermo
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Sacco
- Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy
| | - Marco Racioppi
- Department of Urology Fondazione Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
3
|
Pan DL, Zhang LF, Li XJ, Zhang KP, Gao PF, Yang B, Li NC. Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer. BMC Cancer 2024; 24:159. [PMID: 38297199 PMCID: PMC10829394 DOI: 10.1186/s12885-024-11816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.
Collapse
Affiliation(s)
- Dong-Liang Pan
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Lu-Fang Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China.
| | - Xiao-Jian Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ke-Ping Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Peng-Fei Gao
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Bing Yang
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ning-Chen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| |
Collapse
|
4
|
Moeen AM, Faragallah MA, Zarzour MA, Elbehairy AA, Behnsawy HM. Ileal conduit versus single stoma uretero-cutanoustomy after radical cystectomy in patients ≥ 75 years; which technique is better? a prospective randomized comparative study. Int Urol Nephrol 2023:10.1007/s11255-023-03609-x. [PMID: 37133765 DOI: 10.1007/s11255-023-03609-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To compare the clinical results and patients' health-related quality of life (HR-QoL) of ileal conduit (IC) versus single stoma uretero-cutanoustomy (SSUC) after radical cystectomy in two groups of randomly selected patients ≥ 75 years. METHODS From January 2013 to March 2018, 100 patients ≥ 75 years with muscle invasive BCa underwent RCX and cutaneous diversion. Patients were divided in two groups; group I underwent IC (50 patients) and group II underwent SSUC (50 patients). Postoperative evaluation included clinical, laboratory, radiographic and HR-QoL. The latter was performed using the Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-BL) after 12 months postoperatively. RESULTS Patients' characteristics were comparable between both groups. No intraoperative complications occurred. Early postoperative complications occurred in 27 patients [16 (35.5%) in group I and 11 (23.9%) in group II (p = 0.02)]. Delayed postoperative complications occurred in 26 patients [6 (13.3%) in group I and 20 (43.4%) in group II, (P = 0.002)]. No significant differences between both groups regarding the physical, social/family, emotional, functional and additional concerns scales of FACT-BL questionnaire were reported. CONCLUSION SSUC is a good alternative to IC in elderly frail patients ≥ 75 years and those with multiple comorbidities who require rapid surgery in terms of perioperative complications and HR-QoL. However, the stomal complications and the possibility of a frequent stent exchange are considered its drawbacks.
Collapse
Affiliation(s)
- Ahmed M Moeen
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt.
| | | | - Mohamed A Zarzour
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| | - Ahmed A Elbehairy
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| | - Hosny M Behnsawy
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| |
Collapse
|
5
|
Mostafa MM, Khallaf A, Kamel M, Patil N, Mahdy A. Outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction. Arch Ital Urol Androl 2022; 94:384-389. [PMID: 36576458 DOI: 10.4081/aiua.2022.4.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the early and late outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS The charts of patients with refractory non-malignant LUTD who underwent continent or incontinent external urinary diversion at University of Cincinnati hospitals in the period between March 2012 and December 2019 were retrospectively reviewed. The demographic and baseline characteristics, surgery indications, operative data, early and late outcomes were collected, analyzed, and compared. RESULTS A total of 78 patients including 55 patients with neurogenic bladder (NGB) and 23 patients with non-neurogenic bladder (non-NGB) refractory non-malignant LUTD were included. Fifty-three patients underwent incontinent urinary diversions (IUD), while 25 patients underwent continent urinary diversions (CUD). During the first 4 postoperative weeks, 53.85% (n=42) of patients developed complications, and the incidence was nonsignificantly higher in patients with NGB than those with non- NGB (56.36% vs 47.83%, p-value=0.490). Fever was exclusively encountered in patients with NGB earlier, while stomal retraction occurred only in patients with non-NGB later. More non- NGB patients had early wound infection. There was an overall improvement of urological symptoms in 52 patients (66.67%), and the rate was non-significantly higher in non-NGB patients than NGB patients (78.26% vs 61.82%, p-value=0.160). Late complications were reported in 47 patients and were more encountered in those with non-NGB than those with NGB (65.22% vs 58.18%). Stomal leakage and stenosis occurred more with CUD than with IUD (52% vs 0% and 28% vs 3.77%, respectively). CONCLUSIONS External urinary diversion can achieve a reasonable level of urological symptoms control in patients with refractory non-malignant LUTD, but with associated adverse outcomes. Although non-significantly, these complications tend to be higher in patients with IUD and/or NGB during the early postoperative period and higher with CUD and/or non-NGB on the long-term.
Collapse
Affiliation(s)
- Mostafa M Mostafa
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Asiut University Hospitals, Asiut.
| | - Ashraf Khallaf
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Mohamed Kamel
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Nilesh Patil
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Ayman Mahdy
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| |
Collapse
|
6
|
Struck JP, Hupe MC, Heinisch A, Ozimek T, Hennig MJP, Klee M, von Klot C, Kalogirou C, Kuczyk MA, Merseburger AS, Kramer MW. RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer. Aktuelle Urol 2022; 53:545-551. [PMID: 33445183 DOI: 10.1055/a-1310-3583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality. MATERIAL AND METHODS A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed. RESULTS The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752. CONCLUSION The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa.
Collapse
Affiliation(s)
- Julian Peter Struck
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Marie Christine Hupe
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Annika Heinisch
- Department of Urology and Urologic Oncology, Medical School Hannover, Hannover.,Clinic for Obsterics and Gynecology, Muehlenkreiskliniken, Johannes Wesling Klinikum Minden, Minden
| | - Tomasz Ozimek
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | | | - Melanie Klee
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Christoph von Klot
- Department of Urology and Urologic Oncology, Medical School Hannover, Hannover
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Wuerzburg, Wuerzburg
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Medical School Hannover, Hannover
| | - Axel S Merseburger
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Mario W Kramer
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck
| |
Collapse
|
7
|
Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy. Cancers (Basel) 2022; 14:cancers14215288. [PMID: 36358707 PMCID: PMC9654179 DOI: 10.3390/cancers14215288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Radical cystectomy (RC) is a complex procedure associated with lengthy hospital stays and high complication and readmission rates. We evaluated the impact of patient, surgical, and perioperative factors on discharge disposition following RC at a tertiary referral center. From 2012 to 2019, all bladder cancer patients undergoing RC at our institution were identified (n = 1153). Patients were classified based on discharge disposition: to home or to continued facility-based rehabilitation centers (CFRs, n = 180 (15.61%) patients). On multivariate analysis of patient factors only, age [Risk Ratio (RR): 1.07, p < 0.001)], single marital status (RR: 1.09, p < 0.001), and living alone prior to surgery (RR: 2.55, p = 0.004) were significant predictors of discharge to CFRs. Multivariate analysis of patient, surgical, and perioperative factors indicated age (RR: 1.09, p < 0.001), single marital status (RR: 3.9, p < 0.001), living alone prior to surgery (RR: 2.42, p = 0.01), and major post-operative (Clavien > 3) complications (RR: 3.44, p < 0.001) were significant independent predictors of discharge to CFRs. Of note, ERAS did not significantly impact discharge disposition. Specific patient and perioperative factors significantly impact discharge disposition. Patients who are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to CFRs after RC.
Collapse
|
8
|
Yamada Y, Ikeda M, Hirayama T, Murakami Y, Koguchi D, Matsuda D, Okuno N, Taoka Y, Utsunomiya T, Irie A, Matsumoto K, Iwamura M. Noninferior oncological outcomes in adults aged 80 years or older compared with younger patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma. Asia Pac J Clin Oncol 2022; 19:305-311. [DOI: 10.1111/ajco.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yasufumi Yamada
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
- Department of Urology Sagamihara Kyodo Hospital Sagamihara Japan
| | - Masaomi Ikeda
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | - Takahiro Hirayama
- Department of Urology Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Yasukiyo Murakami
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | - Dai Koguchi
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | | | - Norihiko Okuno
- Department of Urology Sagamihara Hospital Sagamihara Japan
| | - Yoshinori Taoka
- Department of Urology Kitasato University Medical Center Kitamoto Japan
| | | | - Akira Irie
- Department of Urology Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Kazumasa Matsumoto
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | - Masatsugu Iwamura
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| |
Collapse
|
9
|
Rehme C, Fritsch B, Thomas L, Istin S, Burchert C, Hummel B, Baleanu-Curaj B, Reis H, Szarvas T, Ruebben H, Hadaschik B, Niedworok C. Clinical outcome and quality of life in octogenarian patients with muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy or transurethral resection of the bladder tumor: a retrospective analysis of 143 patients. Int Urol Nephrol 2021; 54:71-79. [PMID: 34817753 PMCID: PMC8732805 DOI: 10.1007/s11255-021-03073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare clinical outcome and quality of life (QoL) in octogenarian patients with muscle-invasive urothelial carcinoma (MIBC) either treated by radical cystectomy (RC) or transurethral resection of the tumor (TURBT). METHODS We identified octogenarian patients with MIBC in our institutions since 2005. Clinical treatment outcomes and QoL were analyzed. Uni- and multivariable Cox regression analyses, two-tailed Wilcoxon test, Mann-Whitney test and Fisher's exact test were assessed as appropriate. QoL was evaluated using FACT-G (Functional Assessment of Cancer Therapy-General) questionnaire. RESULTS 143 patients were identified (RC: 51 cases, TURBT: 92 cases). Mean follow-up was 14 months (0-100 months). Median overall survival (OS) was 12 months in the RC group and 7 months in the TURBT group. TURBT and low preoperative hemoglobin were independent risk factors for reduced cancer-specific survival (CSS) (TURBT: p = 0.019, Hb: p = 0.008) and OS (TURBT: p = 0.026, Hb: p = 0.013) in multivariable analyses. Baseline QoL was low throughout the whole cohort. There was no difference in baseline FACT-G scoring comparing RC and TURBT (FACT-G total score (median): RC 43.7/108 vs. TURBT 44.0/108, p = 0.7144). Increased FACT-G questionnaire scoring was assessed for RC patients (median percentage score change RC 22.9%, TURBT 2.3%, p < 0.0001). CONCLUSION RC and TURBT are feasible treatment options for MIBC in octogenarian patients. In our cohort, RC was associated with increased CSS, OS and QoL. QoL in general was low throughout the whole cohort. Interdisciplinary decision-making has to be improved for these critically ill patients.
Collapse
Affiliation(s)
- Christian Rehme
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Beatrix Fritsch
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Luca Thomas
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Stefan Istin
- Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany
| | - Carolin Burchert
- Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany
| | - Bastian Hummel
- Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany
| | | | - Henning Reis
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany.,Department of Urology, Semmelweis University, Budapest, Hungary
| | - Herbert Ruebben
- Department of Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Christian Niedworok
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany. .,Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany.
| |
Collapse
|
10
|
Yu A, Wang Y, Mossanen M, Preston M, Carvalho FL, Chung BI, Chang SL. Robotic-assisted radical cystectomy is associated with lower perioperative mortality in octogenarians. Urol Oncol 2021; 40:163.e19-163.e23. [PMID: 34602361 DOI: 10.1016/j.urolonc.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare perioperative outcomes between robotic and open radical cystectomy in octogenarians using real-world data SUBJECTS AND METHODS: Using the Premier Healthcare Database, we found 13,127 patients who underwent robotic-assisted radical cystectomy (RARC) between 2008 and 2017, of which 15.1% were ≥80 years old. Perioperative mortality was the primary outcome of interest. Secondary outcomes include complications, hospital length of stay, readmission rates, and disposition after discharge. Multivariable regression analysis was used to adjust for patient and hospital characteristics. RESULTS In octogenarians, mortality at the index admission was 2.2% in those who underwent RARC, compared to 4.6% in those who underwent open surgery (P = 0.027). On multivariable analysis, robotic surgery was associated with lower in-hospital mortality in octogenarians (OR 0.46, 95% CI 0.22-0.99, P = 0.047) even after controlling for patient, and hospital characteristics. CONCLUSION RARC is safe and feasible in octogenarians. Elderly patients may derive more benefit from minimally invasive radical cystectomy compared to a younger cohort.
Collapse
Affiliation(s)
- Alice Yu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Ye Wang
- Center for Surgery and Public Health, Brigham, and Women's Hospital, Boston, MA
| | - Matthew Mossanen
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Mark Preston
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Steven L Chang
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
11
|
Savin Z, Herzberg H, Schreter E, Ben-David R, Bar-Yosef Y, Sofer M, Beri A, Yossepowitch O, Mano R. Radical cystectomy and perioperative chemotherapy in octogenarians with bladder cancer. Can Urol Assoc J 2021; 15:E465-E470. [PMID: 33591898 PMCID: PMC8490095 DOI: 10.5489/cuaj.6907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to compare the treatment patterns and oncological outcomes, including postoperative morbidity and chemotherapy use, between octogenarians and patients <80 years of age who underwent radical cystectomy for bladder cancer. METHODS We conducted a retrospective analysis of 119 patients who underwent radical cystectomy for bladder cancer at our center between January 2013 and April 2019. Comorbidities, clinical and pathological data, 30-day postoperative morbidity, and perioperative chemotherapy use were compared between octogenarians (n=31) and younger patients (n=88). Cancer-specific and overall survival rates were estimated with the Kaplan-Meier method and compared between the groups. RESULTS No significant differences were found between the age groups in the clinical and pathological findings, including Charlson comorbidity index, modified frailty index, albumin level, renal function, and TNM stage. The median followup for survivors was 19 months (interquartile range [IQR] 11-30). Major complications (Clavien-Dindo grade ≥3) and 30-day postoperative mortality rates did not differ between the age groups (p=0.3 and p=0.18, respectively). Despite no difference in baseline glomerular filtration rates, perioperative chemotherapy utilization rate was lower among octogenarians compared to younger patients (13% vs. 34%, p=0.03). Estimated two-year cancer-specific survival rates for octo-generians and younger patients were 40% and 75%, respectively. Similarly, estimated two-year overall survival rates were 30% and 69%, respectively. Both cancer-specific and overall survival rates were significantly lower in octogenarians (p=0.007 and p=0.001, respectively). CONCLUSIONS Radical cystectomy in octogenarians results in comparable short-term outcomes as in younger patients. However, in the elderly population, perioperative chemotherapy utilization rates are lower and survival is inferior.
Collapse
Affiliation(s)
- Ziv Savin
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Herzberg
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Schreter
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuben Ben-David
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avi Beri
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
Maffezzini M, Fontana V, Pacchetti A, Dotta F, Cerasuolo M, Chiappori D, Guano G, Mantica G, Terrone C. Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients. ACTA ACUST UNITED AC 2021; 93:15-20. [PMID: 33754602 DOI: 10.4081/aiua.2021.1.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC). METHODS 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC. RESULTS Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed. CONCLUSIONS Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.
Collapse
Affiliation(s)
- Massimo Maffezzini
- Department of Urology, Ospedale Nuovo Legnano, Ospedale Fornaroli Magenta, Milano.
| | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Policlinico San Martino, University of Genova.
| | - Andrea Pacchetti
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Federico Dotta
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Mattia Cerasuolo
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Davide Chiappori
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Giovanni Guano
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Guglielmo Mantica
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| |
Collapse
|
13
|
Joensen UN, Maibom SL, Poulsen AM. Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations. Semin Oncol Nurs 2021; 37:151104. [PMID: 33541734 DOI: 10.1016/j.soncn.2020.151104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To provide a narrative overview of contemporary surgical management of muscle-invasive bladder cancer with focus on radical cystectomy and urinary tract reconstruction. DATA SOURCES International guidelines and a search for articles in PubMed, Medline, and Cochrane Database for single and collaborative studies on surgical management of muscle-invasive bladder cancer. CONCLUSION Patients diagnosed with muscle invasive bladder cancer often have complex treatment and care needs. For those who undergo radical cystectomy as the curative treatment, there is a considerable risk of general complications after major surgery and short- and long-term complications specific to reconstruction of the urinary tract after radical cystectomy. Contemporary care focuses on perioperative optimization to lower rates of major complications, enhanced recovery protocols, and focus on rehabilitation and cancer survivorship. IMPLICATIONS FOR NURSING PRACTICE Nurses are integral members of the multidisciplinary team around patients undergoing surgery for muscle-invasive bladder cancer, and are in a position to coordinate pathways for these patients who often have complex care needs because of preexisting comorbidity and limited personal resources that impede recovery after major surgery and cancer survivorship.
Collapse
Affiliation(s)
- Ulla Nordström Joensen
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sophia Liff Maibom
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | | |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW The orthotopic neobladder and ileal conduit are the two most commonly utilized urinary diversions among patients undergoing radical cystectomy. Although orthotopic diversion offers several advantages, only 20% of patients nationally receive this diversion, with decreasing utilization over time. The purpose of this article is to review advantages of each diversion type and considerations in patient selection, review trends in diversion utilization and perioperative and functional outcomes, and examine recent studies evaluating methods of optimizing diversion selection and patient satisfaction and outcomes. RECENT FINDINGS Decreasing utilization of orthotopic diversion has coincided with the increasing utilization of minimally invasive surgical techniques. A multicentre robotic series demonstrated a higher incidence of high-grade complications with intracorporeal diversion, reflecting the learning-curve associated with this technique. Patient satisfaction with urinary diversion is associated with informed decision-making and goal alignment. Ongoing quality of life studies is aiming to identify predictors of patient satisfaction with the selected urinary diversion and may help guide patient counselling. SUMMARY Given the potential advantages of orthotopic diversion, its decreasing use is a concerning trend. Elucidating patient goals and informed decision-making are critical to patient satisfaction. A patient-centred approach should be used when selecting the type of urinary diversion for a given patient.
Collapse
|
15
|
C-reactive Protein/Albumin Ratio and Acute Kidney Injury after Radical Cystectomy among Elderly Patients: A Propensity Score-Matched Analysis. DISEASE MARKERS 2020; 2020:8818445. [PMID: 33193910 PMCID: PMC7641682 DOI: 10.1155/2020/8818445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
Background The C-reactive protein (CRP)/albumin ratio is a useful index used to represent patient inflammation and nutritional status. Elderly patients are at the highest risk for acute kidney injury (AKI). We clarified the impact of the preoperative CRP/albumin ratio on AKI and evaluated the impact of postoperative AKI on end-stage renal disease (ESRD) among elderly cystectomy patients. Methods We included elderly patients ≥ 65 years of age who underwent radical cystectomy. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to identify risk factors for AKI. Propensity score-matched analysis and conditional logistic regression analysis were performed to elucidate the impact of the CRP/albumin ratio on AKI. The incidence of ESRD was compared between the non-AKI and AKI groups at 12 months after radical cystectomy. Results AKI occurred in 110 patients (32.2%). The CRP/albumin ratio and 6% hydroxyethyl starch amount were risk factors for postoperative AKI. The optimal cut-off value for the CRP/albumin ratio predicting AKI was 0.1. After propensity score matching, the AKI incidence in the CRP/albumin ratio ≥ 0.1 group was higher than that in the CRP/albumin ratio < 0.1 group (46.7% vs. 20.6%, P < 0.001), and a CRP/albumin ratio ≥ 0.1 was associated with a higher AKI incidence (odds ratio = 4.111, P < 0.001). The ESRD incidence was higher in the AKI group than in the non-AKI group (7.3% vs. 1.2%, P = 0.017). Conclusion A CRP/albumin ratio ≥ 0.1 was associated with an increased incidence of AKI, which was associated with higher ESRD incidence among elderly cystectomy patients.
Collapse
|
16
|
Yu J, Lim B, Lee Y, Park JY, Hong B, Hwang JH, Kim YK. Risk factors and outcomes of myocardial injury after non-cardiac surgery in high-risk patients who underwent radical cystectomy. Medicine (Baltimore) 2020; 99:e22893. [PMID: 33120837 PMCID: PMC7581156 DOI: 10.1097/md.0000000000022893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those ≥45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those ≥65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy.This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration ≥0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis.MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010).MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.
Collapse
Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yongsoo Lee
- Department of Anesthesiology and Pain Medicine
| | | | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | |
Collapse
|
17
|
Karabay E, Topaktaş R, Tosun Ç, Karşıyakalı N, Kayar K, Öztürk Mİ. Open radical cystectomy is a reliable surgery with acceptable complication rates in elderly male patients: a retrospective, tertiary hospital-based study. Aging Male 2020; 23:210-215. [PMID: 31621489 DOI: 10.1080/13685538.2019.1678127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: This study aims to evaluate safety of radical cystectomy (RS)+pelvic lymph node dissection (PLND)+ileal conduit urinary diversion (ICUD) in male patients aged >65 years versus ≤65 years.Materials and Methods: Eighty-five male patients who underwent RS + PLND + ICUD for bladder cancer were retrospectively analyzed. The patients were divided into two groups according to age: ≤65 years (Group 1, n = 40) versus >65 years (Group 2, n = 45). Data including baseline demographic and clinical characteristics of the patients, length of hospital stay, and complications within 90 days of surgery, and Grade ≤ II and Grade ≥ III complications according to the Clavien-Dindo (C-D) classification were recorded. Groups were compared in terms of demographic features and development of complications within 90 day after surgery statistically.Results: The median length of hospital stay was statistically significantly longer in Group 2 than Group 1 [10 (7-17) days vs. 9 (6-14) days, respectively; p < .05]. There was no statistically significant difference in the rehospitalization rate within 90 days of surgery between the groups (p > .05).Conclusion: Our study results suggest that RS + PLND + ICUD is a safe procedure in male patients aged ≥65 years.
Collapse
Affiliation(s)
- Emre Karabay
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ramazan Topaktaş
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çağatay Tosun
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Kemal Kayar
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Metin İshak Öztürk
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
18
|
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
| |
Collapse
|
19
|
Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
Collapse
Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
| |
Collapse
|
20
|
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]
|
21
|
Mazzone E, Preisser F, Nazzani S, Tian Z, Zaffuto E, Gallina A, Tilki D, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. The effect of age and comorbidities on early postoperative complications after radical cystectomy: A contemporary population-based analysis. J Geriatr Oncol 2019; 10:623-631. [PMID: 31010691 DOI: 10.1016/j.jgo.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Analyzing the relationship between perioperative outcomes and age in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC) in a continuous fashion may provide detailed information on the increased risk of complications in older patients, even after accounting for different comorbidity profiles. Given the limited data available in the literature, we tested these relationships within a large scale, population-based database. MATERIALS AND METHODS Within the NIS database (2003-2015), we identified patients who underwent RC for UCB. Multivariable logistic regression (MLoR) and Poisson regression (MPR) models were used after adjustment for clustering and stratification for comorbidity profiles. RESULTS Overall, 20,144 patients underwent RC with a median age of 70 years (interquartile range: 62-77). In MLoR models, continuously coded age represented an independent predictor of overall (odds ratio [OR]: 1.008, 95%-confidence interval [CI]: 1.005-1.012), cardiac (OR: 1.042, 95%-CI: 1.035-1.049), vascular (OR: 1.024, 95%-CI: 1.014-1.034), respiratory (OR: 1.016, 95%-CI 1.009-1.022), miscellaneous medical (OR: 1.013, 95%-CI: 1.009-1.017), infectious (OR: 1.012, 95%-CI 1.004-1.019), transfusions (OR: 1.011, 95%-CI 1.007-1.015) and bowel obstruction (OR: 1.009, 95%-CI 1.004-1.013) complications, and in-hospital mortality (OR: 1.057, 95%-CI 1.039-1.075). Conversely, patients age did not predict intraoperative (p = 0.7), genitourinary (p = 0.9), operative wound (p = 0.2) and miscellaneous surgical complications (p = 0.1). In MPR models, patients age predicted longer LOS (relative risk [RR]: 1.002, 95%-CI 1.001-1.003). Finally, a decreasing effect of age was observed in patients low vs high comorbidity burden for cardiac, respiratory and overall complications. CONCLUSIONS Most of early postoperative RC complications are related to patients age, but its impact varies according to comorbidity profile. Further studies are needed to validate our findings that may be then considered for individual counselling and informed consent, as well as for health expenditure planning.
Collapse
Affiliation(s)
- Elio Mazzone
- 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.
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Emanuele Zaffuto
- 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
| | - Andrea Gallina
- 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
| | - Derya Tilki
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- 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
| | - 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
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| |
Collapse
|
22
|
Jodon G, Fischer SM, Kessler ER. Treatment of Urothelial Cancer in Elderly Patients: Focus on Immune Checkpoint Inhibitors. Drugs Aging 2019; 35:409-421. [PMID: 29744750 DOI: 10.1007/s40266-018-0540-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma, or bladder cancer, is a malignancy that most commonly affects older patients. The median age at diagnosis is 73 years, and care of these patients requires consideration not just of the disease-related factors such as stage and histology, but also of patient-related factors. Many of these patients have concurrent medical morbidities and additional changes related to the aging process. Older patients with cancer are a unique population requiring additional considerations and assessment in treatment decision-making. It is important to look beyond chronologic age. The traditional treatment for advanced disease has relied on platinum-based chemotherapy. These multi-agent regimens require consideration of baseline organ function as well as competing conditions that may heighten toxicity. The advent of a new class of cancer therapeutics, the immune checkpoint inhibitors, has changed the care of patients with advanced disease considerably. These immunotherapeutics have been approved for treating patients with disease progression on chemotherapy, or those who are ineligible (or unfit) to receive cisplatin-based therapy. This expansion of the population of patients eligible for treatment has great applicability to the unique considerations in an older patient population. In general, these new immunotherapies are well tolerated and effective in this group of patients.
Collapse
Affiliation(s)
- Gray Jodon
- University of Colorado School of Medicine, Denver, CO, USA
| | - Stacy M Fischer
- University of Colorado School of Medicine, Denver, CO, USA.,University of Colorado Cancer Center, Aurora, USA
| | - Elizabeth R Kessler
- University of Colorado School of Medicine, Denver, CO, USA. .,University of Colorado Cancer Center, Aurora, USA.
| |
Collapse
|
23
|
Rangarajan K, Somani BK. Trends in quality of life reporting for radical cystectomy and urinary diversion over the last four decades: A systematic review of the literature. Arab J Urol 2019; 17:181-194. [PMID: 31489233 PMCID: PMC6711151 DOI: 10.1080/2090598x.2019.1600279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 11/12/2022] Open
Abstract
Objective: To report the trends in quality of life (QoL) reporting for radical cystectomy (RC) and urinary diversion (UD) over the last four decades, as RC for bladder cancer is associated with significant morbidity and QoL issues. Material and methods: We searched PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane library for published studies from January 1980 to January 2017 in the English language. We divided the published articles into three time periods: period-1 (1980-1997), period-2 (1998-2007) and period-3 (2008-2017). Results: A total of 85 QoL studies (8417 patients) were identified, of which 3347 (39.8%) patients had an ileal conduit (IC), 1078 (12.8%) had a continent UD (CD), 3264 (38.8%) had a neobladder (NB), and in the remaining 728 (8.6%) the type of UD was not specified. Whilst there were 15, 24 and 41 studies in period-1, period-2 and period-3 respectively, two (13%), 20 (83%) and 37 (90%) used a validated QoL tool; and none, six (25%) and 23 (56%) used a urology specific QoL tool during these three time periods. Similarly, the number of prospective studies increased from one (7%) to four (17%) and 14 (34%) in these three time periods. The proportion of reported IC patients reduced from 65% (784 patients) to 36% (899) and 35% (1664) from period-1 to period-3, whereas the proportion of NB patients increased from 4.5% (54) to 44% (1105) and 44% (2105). Over the last few years there have been QoL studies on laparoscopic and robotic IC and NB UDs. Conclusion: Our review suggests an increasing use of validated, bladder cancer-specific questionnaires with UD-specific constructs. Abbreviations: BCI: Bladder Cancer Index; BDI: Beck Depression Inventory; BIS: Body Image Scale; CD: continent urinary diversion; EORTC QLQ-30C: European Organisation for the Research and Treatment of Cancer Quality of Life 30-item core questionnaire; ERAS: enhanced recovery after surgery; FACT(-BL)(-G)(-VCI): Functional Assessment of Cancer Therapy(-Bladder Cancer)(-General)(-Vanderbilt Cystectomy Index); IC: ileal conduit; NB: neobladder; (HR)QoL: (health-related) quality of life; (RA)RC: (robot-assisted) radical cystectomy; SF-36: 36-item short-form health survey; SIP: Sickness Impact Profile; UD: urinary diversion.
Collapse
|
24
|
Haden TD, Prunty MC, Jones AB, Deroche CB, Murray KS, Pokala N. Comparative Perioperative Outcomes in Septuagenarians and Octogenarians Undergoing Radical Cystectomy for Bladder Cancer—Do Outcomes Differ? Eur Urol Focus 2018; 4:895-899. [DOI: 10.1016/j.euf.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/01/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022]
|
25
|
Goodstein T, Launer B, White S, Lyon M, George N, DeRonde K, Burke M, O'Donnell C, Lyda C, Kiser TH, Wilson S. A Retrospective Study of Patients Undergoing Radical Cystectomy and Receiving Peri-Operative Naloxegol or Alvimopan: Comparison of Length of Stay. ACTA ACUST UNITED AC 2018; 6:129-134. [PMID: 30574521 DOI: 10.11648/j.js.20180605.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Alvimopan is a μ-opioid receptor antagonist used in the post-operative period to decrease rates of post-operative ileus (POI) following radical cystectomy (RC) and thereby shorten length of stay (LOS). Naloxegol is a much less expensive drug of the same class that has yet to be studied for prevention of POI in the peri-operative period. The purpose of the current study is to evaluate the differences in LOS and development of POI in patients post-RC who take alvimopan versus those who take naloxegol, with the hope that drug efficacy can be evaluated against the significant difference in cost burden between the two drugs. The study population included all adult patients between 18-89 years of age with bladder cancer undergoing radical cystectomy with urostomy at University of Colorado Hospital. Those patients who received usual post-operative care as well as either alvimopan or naloxegol between September 2011 and December 2017 were selected for analysis. Patients who did not take either medication or were switched from one drug to the other were excluded from the study. A zero-truncated binomial regression analysis was used to analyze differences in length of stay in patients who received alvimopan versus those who received naloxegol. Additionally, the incidence of post-operative ileus was compared between treatment groups. 130 patients who underwent RC and received either alvimopan or naloxegol were included in the study: 75 (58%) received alvimopan and 55 (42%) received naloxegol. Baseline characteristics were similar between treatment groups. There was no significant difference in the length of stay between patients who received alvimopan and patients who received naloxegol after adjusting for age, sex, BMI, length of surgical time, or stage of disease (p = 0.41). There was no significant between the two drugs for development of POI (p = 0.85). Development of POI was significantly associated with a longer LOS (p = 0.007). The analysis showed that naloxegol was comparable to alvimopan when it came to length of hospital stay following RC. Therefore, naloxegol may be offered as a less expensive, effective alternative to alvimopan.
Collapse
Affiliation(s)
- Taylor Goodstein
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| | - Bryn Launer
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| | - Sharon White
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| | - Madison Lyon
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| | - Nicholas George
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| | - Kailynn DeRonde
- Connecticut Children's Medical Center, Hartford, USA.,School of Pharmacy, University of Connecticut, Storrs, USA
| | - Michelle Burke
- Department of Pharmacy, University of Colorado Hospital, Aurora, USA
| | - Colin O'Donnell
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| | - Clark Lyda
- Department of Pharmacy, University of Colorado Hospital, Aurora, USA
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, USA
| | - Shandra Wilson
- Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
| |
Collapse
|
26
|
Staging the Host: Personalizing Risk Assessment for Radical Cystectomy Patients. Eur Urol Oncol 2018; 1:292-304. [DOI: 10.1016/j.euo.2018.05.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/12/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
|
27
|
Kirkpatrick C, Haynes A, Sharma P. Antibiotic prophylaxis is not associated with reduced urinary tract infection-related complications after cystectomy and ileal conduit. Bladder (San Franc) 2018; 5:e35. [PMID: 32775477 PMCID: PMC7401989 DOI: 10.14440/bladder.2018.722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Majority of complications after ileal conduit urinary diversion with cystectomy are related to urinary tract infections (UTIs). Controversy exists regarding use of prophylactic antibiotics after surgery. We determined if prophylactic antibiotic use during ureteral stent placement after ileal conduit urinary diversion decreased incidence of UTI-related complications. METHODS We retrospectively identified 75 consecutive patients who underwent ileal conduit urinary diversion with cystectomy at our institution from 2010 to 2016. Patients were stratified based on presence or absence of a UTI-related complication in the 90-day postoperative period. Means were compared with independent t-test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of UTI-related complications. RESULTS Forty-five patients (60%) were prescribed prophylactic antibiotics after surgery. Mean duration of antibiotic use was 15 d, and mean duration of ureteral stenting was 25 d. Most common antibiotics used included fluoroquinolones (n = 23, 30.7%) followed by sulfamethoxazole-trimethoprim (n = 14, 18.7%). Rate of 90-day UTI-related complications was 36% (n = 27), and 90-day UTI-related readmission rate was 14.7% (n = 11). On bivariate and multivariate analysis, prophylactic antibiotic use was not associated with reduced 90-day UTI-related complications (P > 0.05). Patients prescribed prophylactic antibiotics had increased incidence of Clostridium difficile infections in the 90-day postoperative period compared to controls (20% vs. 3.3%; P = 0.038). CONCLUSIONS Prophylactic antibiotic use after ileal conduit urinary diversion with cystectomy was not associated with reduced UTI-related complications, and rate of Clostridium difficile infections was higher in this patient cohort. The effect of early removal of ureteral stents on UTI risk still has to be elucidated.
Collapse
Affiliation(s)
- Carson Kirkpatrick
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Allan Haynes
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| |
Collapse
|
28
|
Ebbing J, Heckmann RC, Collins JW, Miller K, Erber B, Friedersdorff F, Fuller TF, Busch J, Seifert HH, Ardelt P, Wetterauer C, Hosseini A, Jentzmik F, Kempkensteffen C. Oncological outcomes, quality of life outcomes and complications of partial cystectomy for selected cases of muscle-invasive bladder cancer. Sci Rep 2018; 8:8360. [PMID: 29849039 PMCID: PMC5976719 DOI: 10.1038/s41598-018-26089-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/04/2018] [Indexed: 12/27/2022] Open
Abstract
To evaluate the oncological results, associated complications, and postoperative health-related quality of life (HR-QoL) in patients treated with partial cystectomy (PC) for muscle-invasive bladder cancer (MIBC). 27 patients who underwent open PC for cT2 MIBC were included. A simple Cox's proportional hazards regression model was used to assess the association of several potential prognostic factors with survival. Postoperative HR-QoL was assessed with the EORTC (European Organisation for the Research and Treatment of Cancer) QLQ-C30 questionnaire version 3.0. Final pathological tumour stages in PC specimen were: pT0: 18.5%, non-MIBC: 3.7%, MIBC: 74.1%, pCIS: 14.8%. Estimated 5-year overall- and progression-free survival rates were 53.7% and 62.1%. Five (18.5%) patients experienced local recurrence with MIBC. Overall, the salvage cystectomy rate was 18.5%. The 90-day mortality rate was 0%. Significant risk factors for progression-free survival were vascular invasion (HR 5.33) and tumour multilocularity (HR 4.5) in the PC specimen, and a ureteric reimplantation during PC (HR 4.53). The rates of intraoperative complications, 30- and 90-day major complications were 7.4%, respectively and 14.8% for overall long-term complications. Postoperatively, median (IQR) global health status and QoL in our PC cohort was 79.2 (52.1-97.9). Open PC can provide adequate cancer control of MIBC with good HR-QoL in highly selected cases. Open PC can lead to long-term bladder preservation and shows an acceptable rate of severe perioperative complications, even in highly comorbid patients.
Collapse
Affiliation(s)
- Jan Ebbing
- University Hospital Basel, Urological University Clinic Basel-Liestal, Spitalstrasse 21, 4056, Basel, Switzerland.
- Karolinska University Hospital, Department of Urology, Solna, 171 76, Stockholm, Sweden.
| | - Robin Colja Heckmann
- University Hospital Basel, Urological University Clinic Basel-Liestal, Spitalstrasse 21, 4056, Basel, Switzerland
- Charité - University Hospital, Department of Urology, Chariteplatz 1, 10117, Berlin, Germany
| | - Justin William Collins
- Karolinska Institutet, Department of Molecular Medicine and Surgery (MMK), Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
| | - Kurt Miller
- Charité - University Hospital, Department of Urology, Chariteplatz 1, 10117, Berlin, Germany
| | - Barbara Erber
- Vivantes Hospital Am Urban, Department of Urology, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - Frank Friedersdorff
- Charité - University Hospital, Department of Urology, Chariteplatz 1, 10117, Berlin, Germany
| | - Tom Florian Fuller
- Charité - University Hospital, Department of Urology, Chariteplatz 1, 10117, Berlin, Germany
| | - Jonas Busch
- Charité - University Hospital, Department of Urology, Chariteplatz 1, 10117, Berlin, Germany
| | - Hans Helge Seifert
- University Hospital Basel, Urological University Clinic Basel-Liestal, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Peter Ardelt
- University Hospital Basel, Urological University Clinic Basel-Liestal, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Christian Wetterauer
- University Hospital Basel, Urological University Clinic Basel-Liestal, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Abolfazl Hosseini
- Karolinska University Hospital, Department of Urology, Solna, 171 76, Stockholm, Sweden
| | - Florian Jentzmik
- Oberschwaben Clinic, Hospital St. Elisabeth, Department of Urology, Elisabethenstr. 15, 88212, Ravensburg, Germany
| | - Carsten Kempkensteffen
- Charité - University Hospital, Department of Urology, Chariteplatz 1, 10117, Berlin, Germany
- Franziskus Hospital Berlin, Department of Urology, Budapester Strasse 15-19, 10787, Berlin, Germany
| |
Collapse
|
29
|
Pavone C, Candela L, Fontana D, Simonato A. Postoperative complications and 90-day mortality in radical cystectomy in high-risk patients: A monocentric retrospective observational study. Urologia 2018; 85:111-117. [PMID: 30117387 DOI: 10.1177/0391560317751600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM Assessing the incidence of immediate postoperative complications and 90-day mortality in high-risk patients who have undergone radical cystectomy; evaluating the correlation between preoperative conditions and surgery outcomes. MATERIALS AND METHODS This is a monocentric retrospective observational study in which data of 65 patients have been analyzed. High-risk criteria: (a) Age ≥75 years, (b) obesity, (c) age-adjusted Charlson Comorbidity Index ≥8, (d) anemic status, and (e) pT ≥3. More than 50% of patients had two or more "high-risk" indicators. Postoperative complications were assessed through Clavien-Dindo classification. RESULTS Average age of patients was 70.4 years, average age-adjusted Charlson Comorbidity Index was 5.8, and average body mass index was 27.5. In 28% of patients, no complications arose, while in 46% grades I-II complications according to Clavien-Dindo occurred, in 23% grades III-IV complications occurred, and in 3% of the patients, death arose in the immediate postoperative period (grade V). Overall, 90-day mortality rate after surgery was 12.3%. The age ≥75 years and an age-adjusted Charlson Comorbidity Index score ≥8 have shown to be risk factors for the onset of severe complications (odds ratio = 3.54, p = 0.028 and odds ratio = 4.7, p = 0.026), while preoperative anemic status was a risk factor for complications in general (odds ratio = 4.1, p = 0.015). No analyzed parameter was a predictor of 90-day mortality ( p > 0.05). CONCLUSION Immediate postoperative complications and 90-day mortality in radical cystectomy in high-risk patients remain significant, but still in line with the data in the literature on comparable populations. Some of the preoperative parameters were able to predict the outcomes of the intervention with regard to the onset of complications but not to the 90-day mortality.
Collapse
Affiliation(s)
- Carlo Pavone
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Luigi Candela
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Dario Fontana
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| |
Collapse
|
30
|
|
31
|
Dehayni Y, Tetou M, Khdach Y, Janane A, Alami M, Ameur A. [Prognostic of older age for patients with invasive-muscle-bladder cancer and treated by radical cystectomy]. Prog Urol 2018; 28:166-172. [PMID: 29329898 DOI: 10.1016/j.purol.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Bladder tumor is a disease of older persons, but can also occur in young adults, because certainly an influence of environmental factors and a change of lifestyle. The aim of our retrospective analysis is to assess and evaluate the extent of the prognostic impact of age on the carcinological prognosis of invasive-muscle-bladder cancer treated by total cystotomy. METHODS To evaluate the association of patient age with pathological characteristics and recurrence-free and disease survival, we retrospectively reviewed 345 patients with invasive bladder cancer between January 2000 and January 2015. RESULTS We divided our patients into two groups: patients under 65 years of age=150 cases (group 1), patients aged 65 years and over=195 cases (group 2). The 3-year survival rates for patients according to the age groups were 88% and 64% respectively, end the recurrence-free survival 66% and 28%. When age was analysed as a categorical variable, was associated with hydronephrosis (P=0.001), advanced pathological stage (P=0.034), high grade (P=0.026), nodal involvement (P=0.011) and lymphovascular invasion (P=0.008). The multivariate Cox model analysis showed that hydronephrosis and pathological stage was prognostic factors of survival (P=0.012 and P=0.035, respectively). Higher age is significantly associated with the risk of pathologically advanced disease and poorer global survival. CONCLUSION This work allowed us to assert that advanced chronological age is significantly associated with an advanced pathological stage of the disease (volume, pT, grade, lymph nodes) and a low overall survival rate. This could be useful for selecting subjects who would require adjuvant therapy, as well as for planning early complementary therapies. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Y Dehayni
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
| | - M Tetou
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - Y Khdach
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - A Janane
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - M Alami
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - A Ameur
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| |
Collapse
|
32
|
Abstract
Patient selection and preoperative counseling are critical aspects of determining which urinary diversion to perform and should be emphasized at each stage of preoperative planning. The surgeon must have a thorough understanding of the patient's disease process, functional and psycho-emotional status, and social support network so that they can set appropriate expectations. It is also crucial to have a multidisciplinary team of individuals who are experienced with all aspects of urinary diversion care, including ostomy nurses, nurse navigators, and urologic surgeons skilled at teaching and trouble-shooting self-catheterization for continent cutaneous diversion and orthotopic diversion in the setting of hypercontinence.
Collapse
Affiliation(s)
- Elysia Sophia Spencer
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew D Lyons
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
33
|
Parker WP, Smelser W, Lee EK, Habermann EB, Thapa P, Zaid HB, Frank I, Griebling TL, Tollefson MK, Thompson RH, Holzbeierlein JM, Karnes RJ, Boorjian SA. Utilization and Outcomes of Radical Cystectomy for High-grade Non-muscle-invasive Bladder Cancer in Elderly Patients. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30208-2. [PMID: 28844793 DOI: 10.1016/j.clgc.2017.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Radical cystectomy (RC) represents a treatment option for patients with high-grade non-muscle-invasive bladder cancer (HG-NMIBC); however, perioperative morbidity is not insignificant, particularly in elderly patients. We sought to evaluate the associations of age with utilization and outcomes of RC for HG-NMIBC. PATIENTS AND METHODS Patients with HG-NMIBC diagnosed between 2004 and 2013 were identified in the National Cancer Database and stratified by age: ≤ 60, 61-70, 71-80, and > 80 years. Association between age and treatment with RC was assessed by multivariable logistic regression. Associations between age and overall survival were assessed using the Kaplan-Meier method. A multi-institutional analysis was performed to evaluate the associations of age with perioperative outcomes and survival among patients managed with RC for HG-NMIBC. RESULTS On multivariable analysis, age was associated with RC utilization, with the lowest usage in patients > 80 years (2.1%; P < .01). Upstaging at RC occurred in 40% of patients with HG-NMIBC, and no association of age with upstaging risk was noted. Significantly inferior overall survival was observed in the patients who were upstaged across age strata (all P < .01). In the multi-institutional cohort, age was not associated with risks of upstaging, receipt of transfusion, 30-/90-day complications, or recurrence-free or cancer-specific survival (all P > .05), whereas upstaging was associated with inferior recurrence-free and cancer-specific survival regardless of age. CONCLUSION RC for HG-NMIBC is used less frequently in older adults, despite similar risks of pathologic upstaging. As upstaging is associated with inferior survival regardless of age, these data suggest that elderly patients with HG-NMIBC may be at risk for undertreatment.
Collapse
Affiliation(s)
- William P Parker
- Department of Urology, Mayo Clinic, Rochester, MN; Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Woodson Smelser
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Eugene K Lee
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | | | - Prabin Thapa
- Department of Health Services Research, Mayo Clinic, Rochester, MN
| | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Tomas L Griebling
- Department of Urology, University of Kansas Medical Center, Kansas City, KS; The Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS
| | | | | | | | | | | |
Collapse
|
34
|
Curative Treatment for Muscle Invasive Bladder Cancer in Elderly Patients: A Systematic Review. Eur Urol 2017; 73:40-50. [PMID: 28478043 DOI: 10.1016/j.eururo.2017.03.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/13/2017] [Indexed: 12/16/2022]
Abstract
CONTEXT The incidence of muscle invasive bladder cancer (MIBC) increases with age. With increased life expectancy the number of elderly MIBC patients is expected to increase. Existing guidelines on management of MIBC do not preclude curative treatments for elderly patients. However, it is necessary to assess the risks and benefits of a treatment to avoid overtreatment that results in decreased health-related quality of life without prolonging survival. OBJECTIVE To report on overall survival (OS), cancer specific survival (CSS), and morbidity after curative treatment in elderly patients, defined as age >70 yr, with nonmetastatic MIBC and to compare this with the outcome of younger MIBC patients. EVIDENCE ACQUISITION A systematic review was performed using Medline, PubMed, and Embase databases. Articles were included if they addressed one of the three research questions: Only articles including >100 patients and with a clear age-stratification were included. EVIDENCE SYNTHESIS Forty-two articles were retrieved for review. No article directly addressed the use of geriatric assessment. OS and CSS worsen significantly with age both after radical cystectomy and radiotherapy regimens. While POM significantly increases with age, morbidity seems comparable between younger and older patients. CONCLUSIONS Although a proportion of elderly patients with MIBC will benefit from curative treatment, we observed worse OS, CSS, and POM with age. The impact of age on late morbidity is less clear. Prospective studies evaluating geriatric assessments are critically needed to optimize MIBC management in the elderly. PATIENT SUMMARY We performed a systematic review to evaluate the outcome and complication rate in elderly patients with muscle invasive bladder cancer. We observed that overall survival and cancer specific survival significantly decrease and perioperative mortality significantly increases with age. The impact of age on late morbidity is less clear. There is a need for geriatric assessments to select those patients that will benefit from curative treatment.
Collapse
|
35
|
Krajewski W, Zdrojowy R, Tupikowski K, Małkiewicz B, Kołodziej A. How to lower postoperative complications after radical cystectomy - a review. Cent European J Urol 2016; 69:370-376. [PMID: 28127453 PMCID: PMC5260457 DOI: 10.5173/ceju.2016.880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/16/2016] [Accepted: 10/13/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Lowering morbidity and mortality after RC is subject of considerable interest. Lately, many evidence-based data on improvements in operative technique, anesthetic management, and patient care have been published. In this article, we present a review of literature on how to lower postoperative complications after RC. Material and methods The Medline, and Web of Science databases were searched without a time limit on February 2016 using the terms ‘cystectomy’ in conjunction with ‘radical’, ‘bladder cancer’, ‘complications’ or ‘management’. Boolean operators (NOT, AND, OR) were also used in succession to narrow and broaden the search. The search was limited to the English, Polish and Spanish literature. Results Many complications may be avoided by appropriate patient selection and meticulous introduction of care protocols. Conclusions RC as treatment free of complications, even in the hands of an experienced urologist, does not exist. A large number of complications are acceptable in the name of good long-term results. Optimum results are possible with proper surgical technique, good patients and urinary diversion selection and proper patient management in the pre-, peri, and postoperative period.
Collapse
Affiliation(s)
- Wojciech Krajewski
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Tupikowski
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW Orthotopic urinary diversion has been performed for more than 30 years. Although it is considered to be the gold standard form of diversion in many centers of expertise, however it is uncommonly performed outside these institutions. The purpose of this article is to review the current indications and outcomes of orthotopic diversion with a focus on male patients and to explore potential barriers to wider dissemination of the technique. RECENT FINDINGS Approximately 75% of patients undergoing radical cystectomy today are candidates for orthotopic diversion and in the absence of absolute contraindications, very few patients chose to undergo an ileal conduit for personal reasons. In a recent quality of life study, the orthotopic neobladder was better than ileal conduit in terms of global health status and physical functioning. In a prospective randomized trial comparing a refluxing versus nonrefluxing neobladder, there was no difference in renal function after 3 years. There is currently insufficient evidence to suggest improved perioperative outcomes with the use of minimally invasive techniques. SUMMARY There are very few absolute contraindications for an orthotopic neobladder, which remains the gold standard form of diversion at many centers of expertise. Surgeon experience and thorough preoperative counseling with realistic expectations can ensure optimal outcomes and patient satisfaction.
Collapse
|
37
|
Tan WS, Lamb BW, Tan MY, Ahmad I, Sridhar A, Nathan S, Hines J, Shaw G, Briggs TP, Kelly JD. In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion. Eur Urol Focus 2016; 3:273-279. [PMID: 28753745 DOI: 10.1016/j.euf.2016.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/16/2016] [Accepted: 06/02/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) is an attractive option to open cystectomy, but the benefit in terms of improved outcomes is not established. OBJECTIVE To evaluate the early postoperative morbidity and mortality of patients undergoing iRARC and conduct a critical analysis of complications using standardised reporting criteria as stratified according to urinary diversion. DESIGN, SETTING, AND PARTICIPANTS A total of 134 patients underwent iRARC for bladder cancer at a single centre between June 2011 and July 2015. INTERVENTION Radical cystectomy with iRARC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient demographics, pathologic data, and 90-d perioperative mortality and complications were recorded. Complications were reported according to the Clavien-Dindo (CD) classification and stratified according to urinary diversion type and either surgical or medical complications. The chi-square test and t test were used for categorical and continuous variables respectively. Multivariable logistic regression was performed on variables with significance in univariate analysis. RESULTS AND LIMITATIONS The 90-d all complication rate following ileal conduit and continent diversion was 68% and 82.4%, and major complications were 21.0% and 20.6% respectively. The 90-d mortality was 3% and 2.9% for ileal conduit and continent diversion patients, respectively. On multivariate analysis, the blood transfusion requirement was independently associated with major complications (p=0.002) and all 30-d (p=0.002) and 90-d (p=0.012) major complications. Male patients were associated with 90-d major complications (p=0.015). Critical analysis identified that surgical complications were responsible for 39.4% of all 90-d major complications. The incidence of surgical complications did not decline with increasing number of iRARC cases performed (p=0.742, r=0.31). Limitations of this study include its retrospective nature, limited sample size, and limited multivariate analysis due to the low number of major complications events. CONCLUSIONS Although complications following iRARC are common, most are low grade. A critical analysis identified surgical complications as a cause of major complications. Addressing this issue could have a significant impact on lowering the morbidity associated with iRARC. PATIENT SUMMARY We looked at the surgical outcomes in bladder cancer patients treated with minimally invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from a different centre even in a randomised trial setting.
Collapse
Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
| | - Benjamin W Lamb
- Department of Urology, University College London Hospital, London, UK
| | - Mae-Yen Tan
- Uro-oncology Group, Cancer Research UK, Beatson Institute, Glasgow University, Glasgow, UK
| | - Imran Ahmad
- Department of Urology, University College London Hospital, London, UK; Uro-oncology Group, Cancer Research UK, Beatson Institute, Glasgow University, Glasgow, UK
| | - Ashwin Sridhar
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Senthil Nathan
- Division of Surgery and Intervention Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - John Hines
- Department of Urology, University College London Hospital, London, UK
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, UK
| | - Timothy P Briggs
- Department of Urology, University College London Hospital, 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
| |
Collapse
|
38
|
De Groote R, Gandaglia G, Geurts N, Goossens M, Pauwels E, D'Hondt F, Gratzke C, Fossati N, De Naeyer G, Schatteman P, Carpentier P, Novara G, Mottrie A. Robot-Assisted Radical Cystectomy for Bladder Cancer in Octogenarians. J Endourol 2016; 30:792-8. [PMID: 26914490 DOI: 10.1089/end.2016.0050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate perioperative morbidity and mortality rate, a 3-year recurrence-free survival, and cancer-specific mortality rate in patients older than 80 years undergoing robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS We retrospectively collected data of 155 consecutive patients who received RARC for muscle-invasive or high-risk nonmuscle-invasive urothelial carcinoma of the bladder between 2003 and 2014 at a high-volume robotic center. Diversion was performed intra- or extracorporeally according to the surgeon's preferences. Complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the impact of age on postoperative outcomes. RESULTS Of 155 consecutive patients, 22 (14.2%) patients were 80 years or older. Octogenarians did not significantly differ from younger patients in ASA score (p = 0.4) and Charlson comorbidity index (p = 0.4). Prevalence of any grade and high-grade complications was similar in both groups (all p ≥ 0.6). Older patients had a significantly higher pathologic tumor grade (p = 0.04) and a lower use of pelvic lymphadenectomy (p < 0.001). No perioperative mortality rate was recorded within 90 days from surgery. Elderly patients had a similar risk of 3-year oncologic recurrence after surgery compared with their younger counterparts (odds ratio [OR] 1.63; p = 0.2). Conversely, the risk of cancer-specific mortality rate was significantly higher (OR 2.78; p = 0.02). CONCLUSIONS Patients 80 years or older undergoing RARC for bladder cancer did not have a higher risk of peri- and postoperative morbidity and mortality rate and had a similar 3-year recurrence-free survival, suggesting that RARC can be safely performed in selected elderly patients by experienced surgeons.
Collapse
Affiliation(s)
| | - Giorgio Gandaglia
- 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .,2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .,3 Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele , Milan, Italy
| | - Nicolas Geurts
- 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium
| | | | | | | | - Christian Gratzke
- 4 Urologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians Universität München , Munich, Germany
| | - Nicola Fossati
- 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .,2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .,3 Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele , Milan, Italy
| | | | | | | | - Giacomo Novara
- 2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .,5 Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua , Padua, Italy
| | - Alexandre Mottrie
- 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .,2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium
| |
Collapse
|
39
|
Erlich A, Zlotta AR. Treatment of bladder cancer in the elderly. Investig Clin Urol 2016; 57 Suppl 1:S26-35. [PMID: 27326404 PMCID: PMC4910758 DOI: 10.4111/icu.2016.57.s1.s26] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 12/16/2022] Open
Abstract
As the population ages and life expectancy increases in the human population, more individuals will be diagnosed with bladder cancer (BC). The definition of who is elderly is likely to change in the future from the commonly used cut-off of ≥75 years of age. Physiological rather than chronological age is key. BC care in the elderly is likely to become a very common problem in daily practice. Concerns have been raised that senior BC patients are not given treatments that could cure their disease. Clinicians lack quantitative and reliable estimates of competing mortality risks when considering treatments for BC. Majority of patients diagnosed with BC are elderly, making treatment decisions complex with their increasing number of comorbidities. A multidisciplinary approach to these patients may be a way to incorporate discussion from various disciplines regarding treatment options available. Here we review various treatment options for elderly patients with muscle invasive BC and nonmuscle invasive BC. We include differences in treatments from robotic versus open radical cystectomy, various urinary diversion techniques, chemotherapy, radiation therapy and combination treatments. In clinical practice, treatment decisions for elderly patients should be done on a case-by-case basis, tailored to each patient with their specific histories and comorbidities considered. Some healthy elderly patients may be better candidates for extensive curative treatments than their younger counterparts. This implies that these important, life-altering decisions cannot be solely based on age as many other factors can affect patient survival outcomes.
Collapse
Affiliation(s)
- Annette Erlich
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
40
|
Ikehata Y, Tanaka T, Ichihara K, Kobayashi K, Kitamura H, Takahashi S, Masumori N. Incidence and risk factors for acute kidney injury after radical cystectomy. Int J Urol 2016; 23:558-63. [DOI: 10.1111/iju.13104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Yoshinori Ikehata
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Toshiaki Tanaka
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Koji Ichihara
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Ko Kobayashi
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Hiroshi Kitamura
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Satoshi Takahashi
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Naoya Masumori
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| |
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW The number of cases of muscle-invasive bladder cancer is increasing along with the age of the population. Management of muscle-invasive bladder cancer in the elderly is complex, requiring a multidisciplinary team approach and a comprehensive assessment of each individual patient. RECENT FINDINGS A geriatric assessment should be used to inform treatment decisions in elderly patients with bladder cancer. There is increasing evidence to support aggressive therapy in appropriate elderly patients, including radical cystectomy and neoadjuvant chemotherapy. Adjuvant chemotherapy also has a role in patients with high-risk disease after cystectomy. A bladder preservation approach with trimodality therapy is a well tolerated and effective alternative to cystectomy in appropriately selected patients. SUMMARY Treatment decisions should not be based on chronologic age alone and advanced age should not preclude aggressive or curative therapy. The recent molecular characterization of bladder cancer and several recent immunotherapy trials provide hope of a more targeted approach to treatment of bladder, potentially improving both effectiveness and tolerability of treatment regimens in the elderly.
Collapse
|
42
|
Moschini M, Simone G, Stenzl A, Gill IS, Catto J. Critical Review of Outcomes from Radical Cystectomy: Can Complications from Radical Cystectomy Be Reduced by Surgical Volume and Robotic Surgery? Eur Urol Focus 2016; 2:19-29. [PMID: 28723446 DOI: 10.1016/j.euf.2016.03.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 12/12/2022]
Abstract
CONTEXT Radical cystectomy (RC) is a highly complex procedure with multiple risks for perioperative complications. OBJECTIVE We reviewed the literature to report perioperative outcomes and the incidence of complications in contemporary RC series. We focused on the potential impact of surgical approach and surgeon volume on these outcomes. EVIDENCE ACQUISITION A systematic literature search was performed in December 2015 using the Medline, Embase, and Web of Science databases for articles published in English between 2005 and 2015. The search strategy included the terms complications, cystectomy, robotic assisted radical cystectomy, and surgical volume, alone or in combination. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. EVIDENCE SYNTHESIS Our searches retrieved 49 papers. Open RC (ORC) and robot-assisted RC (RARC) are morbid procedures with consistent risk of perioperative complications (mean weighted incidence: 48.7%; range: 27.0-72.5%). Higher hospital and surgeon volumes were associated with reduced risks of perioperative complications. Prior robotic expertise in radical prostatectomy showed a beneficial protective risk on development of complications after RARC. Surgical volume appears to be a good predictor of safety in ORC and RARC. RARC is associated with reduced estimated blood loss and lower perioperative transfusion rates compared with ORC. Further evidence is needed to support the reproducibility of intracorporeal diversion during RARC, beyond large tertiary referral centers. Several strategies have been demonstrated to be effective for reducing the risk of incurring perioperative complications and should be pursued by physicians. CONCLUSIONS Despite improvements in quality of care, RC remains a challenging procedure with high morbidity, regardless of surgical approach. RARC is a safe procedure with potential advantages in terms of reduced blood loss and transfusion rates. Surgical volume appears to be related to the improvement of perioperative outcomes and complications. PATIENT SUMMARY Radical cystectomy is a challenging and morbid procedure. The robotic approach has gained popularity and proved to be safe and effective in tertiary referral centers, although further studies are needed to confirm its wide reproducibility. Centers with higher surgical volume have lower incidence of perioperative complications.
Collapse
Affiliation(s)
- Marco Moschini
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Milan, Italy.
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | - Inderbir S Gill
- University of Southern California Institute of Urology, Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, Los Angeles, CA, USA
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| |
Collapse
|
43
|
Spahn M, Boxler S. [Urinary diversion in elderly patients]. Urologe A 2015; 54:1753-7. [PMID: 26704277 DOI: 10.1007/s00120-015-4010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bladder cancer represents one of the ten most prevalent cancers worldwide. More than 400,000 people worldwide are newly diagnosed every year. Within 2 years after diagnosis, 80% of patients with muscle invasive bladder cancer without treatment die. METHODS The aggressive local surgical approach with a cystectomy is the therapy of choice. The median age of patients with de novo bladder cancer is 70 years. Thus bladder cancer is a cancer of the elderly. For demographical reasons, the number of eldery patients undergoing radical cystectomy will rise in the next few years. The type of urinary diversion is a major factor influencing perioperative morbidity and quality of life in these patients. Incontinent urinary diversions are preferentially used in daily practice. CONCLUSIONS There are only a few contraindications for orthotopic neobladder; however, age alone is not a contraindication. Patient selection and a nerve sparing approach are crucial in men and women to achieve excellent functional results with orthotopic neobladder in elderly patients.
Collapse
Affiliation(s)
- M Spahn
- Urologische Universitätsklinik, Inselspital Bern, Anna Seiler-Haus, CH-3010, Bern, Schweiz.
| | - S Boxler
- Urologische Universitätsklinik, Inselspital Bern, Anna Seiler-Haus, CH-3010, Bern, Schweiz
| |
Collapse
|
44
|
Stensland KD, Galsky MD. Current approaches to the management of bladder cancer in older patients. Am Soc Clin Oncol Educ Book 2015:e250-6. [PMID: 24857110 DOI: 10.14694/edbook_am.2014.34.e250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bladder cancer is largely a disease of older adults, with nearly half of diagnoses occurring in those older than age 75. This has led to a disconnect between the efficacy and effectiveness of various treatment strategies. For example, surgical removal of the bladder is a potentially curative approach to muscle-invasive disease, although the large single-center and multicenter series that have established the efficacy of this approach include only a small proportion of older patients. Similarly, clinical trials that have established optimal chemotherapeutic regimens for use in the perioperative and metastatic settings comprise largely younger patients. Extrapolating the available evidence to the population of older patients with bladder cancer requires careful assessment of an individual patient's functional status and comorbidities to estimate the likelihood of treatment-related harms. This should be coupled with an understanding of an individual patient's goals of therapy, independence, estimated longevity, and social support to facilitate a shared medical decision regarding treatment. The use of validated approaches to geriatric assessment may refine risk stratification in older adults, although practical challenges have prevented uniform adoption in routine clinical practice.
Collapse
Affiliation(s)
- Kristian D Stensland
- From the Department of Medicine, Division of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Urology, Ichan School of Medicine at Mount Sinai, New York, NY
| | - Matthew D Galsky
- From the Department of Medicine, Division of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Urology, Ichan School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
45
|
James AC, Izard JP, Holt SK, Calvert JK, Wright JL, Porter MP, Gore JL. Root Causes and Modifiability of 30-Day Hospital Readmissions after Radical Cystectomy for Bladder Cancer. J Urol 2015; 195:894-9. [PMID: 26555956 DOI: 10.1016/j.juro.2015.10.175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Radical cystectomy is associated with high complication and rehospitalization rates. An understanding of the root causes of hospital readmissions and the modifiability of factors contributing to readmissions may decrease the morbidity associated with radical cystectomy. We characterize the indications for rehospitalization following radical cystectomy, and determine whether these indications represent immutable patient disease and procedure factors or whether they are modifiable. MATERIALS AND METHODS From MarketScan® databases we identified patients younger than 65 years with a diagnosis of bladder cancer who underwent radical cystectomy between 2008 and 2011 and were readmitted to the hospital within 30 days of radical cystectomy. All associated ICD-9 codes in the index admission, subsequent outpatient claims and readmission claims were independently reviewed by 3 surgeons to determine a root cause of rehospitalization. Causes were broadly categorized as medical, surgical or infectious, and reviewers determined whether the readmission was modifiable. Multivariate logistical regression models were used to identify factors associated with rehospitalization. RESULTS A total of 1,163 patients were included in the study and 242 (21%) were readmitted to the hospital within 30 days. Of these readmissions 26% were considered modifiable (kappa=0.71). Of the nonmodifiable readmissions an infectious cause accounted for 52% and a medical cause accounted for 48%, whereas of the modifiable readmissions 62% were due to surgical causes, 30% to medical and 8% to infectious causes. On multivariate analysis only discharge to a skilled nursing facility was associated with modifiable (OR 6.12, 95% CI 2.32-16.14) or nonmodifiable (OR 3.27, 95% CI 1.63-6.53) hospital readmissions. CONCLUSIONS The majority of rehospitalizations after radical cystectomy are attributable its inherent morbidity. However, optimization of aspects of peri-cystectomy care could minimize the morbidity of radical cystectomy.
Collapse
Affiliation(s)
- Andrew C James
- Department of Urology, University of Kentucky School of Medicine, Lexington, Kentucky.
| | - Jason P Izard
- Department of Urology, Queens University, Kingston, Ontario, Canada
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Joshua K Calvert
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Michael P Porter
- Department of Urology, University of Washington School of Medicine, Seattle, Washington; Puget Sound Veterans Affairs Health Care System, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
46
|
Aboumarzouk OM, Bondad J, Ahmed K, Khan MS, Kynaston HG, Dasgupta P, Guru K, Chlosta PL. Robotic versus open radical cystectomy for bladder cancer in adults. Hippokratia 2015. [DOI: 10.1002/14651858.cd011903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Omar M Aboumarzouk
- Islamic University of Gaza; Department of Urology; College of Medicine Gaza Palestine
| | - Jasper Bondad
- Southend Hospital; Department of Urology; Prittlewell Chase Westcliff-on-Sea UK SS0 0RY
| | - Kamran Ahmed
- King's College London; MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of Medicine; St Thomas Street London England UK SE1 9RT
| | - Mohammed S Khan
- King's College London; MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of Medicine; St Thomas Street London England UK SE1 9RT
| | - Howard G Kynaston
- University Hospital Wales; Department of Urology; Heath Park Cardiff UK CF14 4XW
| | - Prokar Dasgupta
- King's College London; MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of Medicine; St Thomas Street London England UK SE1 9RT
| | - Khurshid Guru
- Roswell Park Cancer Institute; Department of Urology; Buffalo New York USA
| | - Piotr L Chlosta
- Jagiellonian University, Collegium Medicum; Department of Urology; Grzegorzecka 18 Krakow Poland 31531
| |
Collapse
|
47
|
Orthotopic urinary diversion in the elderly. World J Urol 2015; 34:13-8. [DOI: 10.1007/s00345-015-1696-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
|
48
|
Guancial EA, Roussel B, Bergsma DP, Bylund KC, Sahasrabudhe D, Messing E, Mohile SG, Fung C. Bladder cancer in the elderly patient: challenges and solutions. Clin Interv Aging 2015; 10:939-49. [PMID: 26089655 PMCID: PMC4467651 DOI: 10.2147/cia.s74322] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Bladder cancer (BC) is an age-associated malignancy with increased prevalence in the elderly population. Elderly patients are a vulnerable population at increased risk for treatment-related toxicity secondary to medical comorbidities and geriatric syndromes. As a result, this population has been historically undertreated and suffers worse disease-specific outcomes than younger patients with BC. Recognition of this disparity has led to efforts to individualize treatment decisions based on functional status rather than chronologic age in an effort to optimize the use of curative therapies for the fit elderly and modify treatments to reduce the risk of toxicity and disease-related morbidity in vulnerable or frail patients. The comprehensive geriatric assessment is a decision framework that helps to balance underlying health considerations and risks of therapy with aggressiveness of the cancer. Development of systemic therapies with increased efficacy against BC and reduced toxicity are eagerly awaited, as are techniques and interventions to reduce the morbidity from surgery and radiation for patients with BC.
Collapse
Affiliation(s)
- Elizabeth A Guancial
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Breton Roussel
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Derek P Bergsma
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Kevin C Bylund
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Deepak Sahasrabudhe
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Edward Messing
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Supriya G Mohile
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Chunkit Fung
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
49
|
Leveridge MJ, Siemens DR, Mackillop WJ, Peng Y, Tannock IF, Berman DM, Booth CM. Radical Cystectomy and Adjuvant Chemotherapy for Bladder Cancer in the Elderly: A Population-based Study. Urology 2015; 85:791-8. [DOI: 10.1016/j.urology.2014.12.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
|
50
|
Fontana PP, Gregorio SAY, Rivas JG, Sánchez LC, Ledo JC, Gómez ÁT, Sebastián JD, Barthel JJDLP. Perioperative and survival outcomes of laparoscopic radical cystectomy for bladder cancer in patients over 70 years. Cent European J Urol 2015; 68:24-9. [PMID: 25914834 PMCID: PMC4408395 DOI: 10.5173/ceju.2015.01.498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/12/2014] [Accepted: 01/10/2015] [Indexed: 12/27/2022] Open
Abstract
Introduction Radical cystectomy in elderly patients is a controversial issue that has noticed an increase in importance overtime because of the lengthening average life span. Our objective was to determine if there were significant differences in the perioperative outcomes of patients over 70 years with bladder cancer treated with laparoscopic radical cystectomy (LRC) compared to those of younger patients. Material and methods We selected 180 patients who underwent LRC in our department in the period between 2005-2012. We divided them into 2 groups: 57% <70 years and 43% >70 years, and we compared the different parameters such as: comorbidities, intraoperative and post-operative complications, TNM stage and overall survival. Results The group <70 years had less comorbidities when compared with the group >70 years. Heterotopic urinary diversion was the diversion of choice in the elderly patients (97.4%). Paralytic ileus and the worsening of renal function were the only complications with statistical differences between the groups. Mean hospital length of stay was not significantly different between the groups. Younger and older patients had similar pathological staging : pT1 or less: 26,2 vs. 18.2%, pT2: 19.4 vs. 16.9%, pT3 38.8 vs. 37.7% and pT4 15.6 vs. 17.2%. Kaplan-Meier curves did not show significant differences in survival. Conclusions Laparoscopic radical cystectomy in the elderly patient has similar rates of perioperative morbidity when compared with the younger patient and may be offered as a treatment option in selected elderly patients.
Collapse
Affiliation(s)
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | |
Collapse
|