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Blachier M, Ye H, Long JA, Descotes JL, Fiard G. Interest of the POSPOM score in estimating postoperative complication risk after radical cystectomy. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102610. [PMID: 38460938 DOI: 10.1016/j.fjurol.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Identifying patients at risk after cystectomy for cancer is essential. The POSPOM score is a non-specific urological surgery score for estimating postoperative hospital mortality. This study sought to validate the POSPOM score for predicting postoperative morbidity and mortality after cystectomy. METHODS The study retrospectively included all patients undergoing cystectomy for muscle-invasive or locally advanced bladder cancer between 2010 and 2019 in one center. The primary objective was validation of the POSPOM score for calculating severe postoperative morbidity [Clavien-Dindo (CDC)≥3] and 90-day mortality after cystectomy. Secondary objectives were comparison to other predictive scores [Charlson (CCI), ASA]. RESULTS At 90days, out of 167 patients, 26% (n=44) had a CDC≥3 complication and 8.4% (n=14) had died. POSPOM correlated with the risk of death at 90days (P<0.001) and postoperative transfusion (P<0.01). Patients with CDC≥3 complications had higher CCI and POSPOM (median 6.5 vs. 5, P<0.01 and 6.49% vs. 5.58%, P=0.029, respectively). Patients who died postoperatively had higher CCI and POSPOM (median 8 vs. 6, P<0.001 and 23.9% vs. 5.58%, P<0.001, respectively). The prognostic value of the POSPOM score for predicting mortality appears better [AUC=0.886 (0.798-0.973)] compared with CCI [AUC=0.812 (0.710-0.915)] and ASA [AUC=0.739 (0.630-0.849)], but not for predicting morbidity. CONCLUSION This study confirms the robustness of the POSPOM score for estimating mortality and its limitations for predicting postoperative morbidity. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Mathieu Blachier
- Service d'urologie, CHU Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 9, France.
| | - Haixia Ye
- Service d'urologie, hôpital Bichat-Claude-Bernard, Paris, France
| | | | - Jean-Luc Descotes
- Service d'urologie, CHU Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 9, France
| | - Gaelle Fiard
- Service d'urologie, CHU Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 9, France
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Fugazzola P, Carbonell-Morote S, Cobianchi L, Coccolini F, Rubio-García JJ, Sartelli M, Biffl W, Catena F, Ansaloni L, Ramia JM. Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study. World J Emerg Surg 2024; 19:12. [PMID: 38515141 PMCID: PMC10956255 DOI: 10.1186/s13017-024-00539-6] [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: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. OBJETIVE The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. MATERIALS AND METHODS This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. OUTCOMES 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. CONCLUSION Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.
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Affiliation(s)
- Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Carbonell-Morote
- Servicio de Cirugía General. Hospital General Universitario Dr. Balmis, Alicante, Spain.
- ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain.
- Department of Pathology. and Surgery, Universidad Miguel Hernandez, Ctra Valencia 23C, 03550, Sant Joan d´Alacant, Spain.
| | - Lorenzo Cobianchi
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, Pisa, Italy
| | - Juan Jesús Rubio-García
- Servicio de Cirugía General. Hospital General Universitario Dr. Balmis, Alicante, Spain
- ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain
| | - Massimo Sartelli
- Macerata Hospital, 62100, Macerata, Italy
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
| | - Jose Manuel Ramia
- Servicio de Cirugía General. Hospital General Universitario Dr. Balmis, Alicante, Spain
- ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain
- Department of Pathology. and Surgery, Universidad Miguel Hernandez, Ctra Valencia 23C, 03550, Sant Joan d´Alacant, Spain
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Hançerli CÖ, Doğan N. Comparison of below-knee and above-knee amputations with demographic, comorbidity, and haematological parameters in patients who died. J Foot Ankle Res 2023; 16:36. [PMID: 37308964 DOI: 10.1186/s13047-023-00635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND This study aimed to establish mortality predictive parameters with a higher contribution to mortality by comparing the demographic data, comorbid factors, and haematological values of patients who underwent below-knee and above-knee amputation and had died during the follow-up period. MATERIALS AND METHODS Between March 2014 and January 2022, 122 patients in a single centre who developed foot gangrene due to chronic diabetes and underwent below-knee or above-knee amputation were evaluated retrospectively. Patients who died of natural causes during the post-operative period were included in the study. Those who were amputated below the knee were assigned to Group 1, and those who were amputated above the knee were assigned to Group 2. The patients' age, gender, side of amputation, comorbid diseases, American Society of Anaesthesiologists (ASA) score, Charlson comorbidity index (CCI), death time, and haematological values at the time of first admission were compared between the two groups and statistical analyses were performed. RESULTS Group 1 (n = 50) and Group 2 (n = 37) had similar distributions in terms of age, gender, side of operation, number of comorbidities, and CCI (p > 0.05). Group 2's mean ASA score and c-reactive protein (CRP) levels were statistically higher than those of Group 1 (p < 0.05). Death time, albumin value, and HbA1c levels were statistically lower in Group 2 than in Group 1 (p < 0.05). There were no significant differences between the groups in haemogram, white blood cells (WBC), lymphocytes, neutrophils, creatinine, and Na values at the time of first admission (p > 0.05). CONCLUSION A high ASA score, low albumin value, and high CRP value were significant predictors of high mortality. Creatinine levels and HbA1c values were quite ineffective in predicting mortality. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
- Cafer Özgür Hançerli
- Department of Orthopaedics and Traumatology, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Necati Doğan
- Department of Orthopaedics and Traumatology, Başaksehir Çam and Sakura City Training and Research Hospital, Basaksehir Olimpiyat Bulvarı Yolu, 34480, Basaksehir, Istanbul, Turkey.
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Sugawara T, Rodriguez Franco S, Sherman S, Kirsch MJ, Colborn K, Ishida J, Grandi S, Al-Musawi MH, Gleisner A, Schulick RD, Del Chiaro M. Association of Adjuvant Chemotherapy in Patients With Resected Pancreatic Adenocarcinoma After Multiagent Neoadjuvant Chemotherapy. JAMA Oncol 2023; 9:316-323. [PMID: 36480190 PMCID: PMC9857517 DOI: 10.1001/jamaoncol.2022.5808] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022]
Abstract
Importance The total number of patients with pancreatic ductal adenocarcinoma (PDAC) who receive neoadjuvant chemotherapy (NAC) is increasing. However, the added role of adjuvant chemotherapy (AC) in these patients remains unknown. Objective To evaluate the association of AC with overall survival (OS) in patients with PDAC who received multiagent NAC followed by curative-intent surgery. Design, Setting, and Participants This retrospective, matched-cohort study used data from the National Cancer Database and included patients with PDAC diagnosed between 2010 and 2018. The study included patients at least 18 years of age who received multiagent NAC followed by surgical resection and had available records of the pathological findings. Patients were excluded if they had clinical or pathological stage IV disease or died within 90 days of their operation. Exposures All included patients received NAC and underwent resection for primary PDAC. Some patients received adjuvant chemotherapy. Main Outcomes and Measures The main outcome was the OS of patients who received AC (AC group) vs those who did not (non-AC group). Interactions between pathological findings and AC were investigated in separate multivariable Cox regression models. Results In total, 1132 patients (mean [SD] age, 63.5 [9.4] years; 577 [50.1%] male; 970 [85.7%] White) were included, 640 patients in the non-AC group and 492 patients in the AC group. After being matched by propensity score according to demographic and pathological characteristics, 444 patients remained in each group. The multivariable Cox regression model adjusted for all covariates revealed an association between AC and improved survival (hazard ratio, 0.71; 95% CI, 0.59-0.85; P < .001). Subgroup interaction analysis revealed that AC was significantly associated with better OS (26.6 vs 21.2 months; P = .002), but the benefit varied by age, pathological T category, and tumor differentiation. Of note, AC was associated with better survival in patients with any pathological N category and positive margin status. Conclusions and Relevance In this cohort study, AC following multiagent NAC and resection in patients with PDAC was associated with significant survival benefit compared with that in patients who did not receive AC. These findings suggest that patients with aggressive tumors may benefit from AC to achieve prolonged survival, even after multiagent NAC and curative-intent resection.
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Affiliation(s)
- Toshitaka Sugawara
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Salvador Rodriguez Franco
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Samantha Sherman
- Department of Surgery, Parkview Hospital Randallia, Fort Wayne, Indiana
| | - Michael J. Kirsch
- Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Kathryn Colborn
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora
| | - Jun Ishida
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Samuele Grandi
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Mohammed H. Al-Musawi
- Clinical Trials Office, Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Ana Gleisner
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora
| | - Richard D. Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora
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Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Røder MA. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open 2021; 11:e043266. [PMID: 33853799 PMCID: PMC8054090 DOI: 10.1136/bmjopen-2020-043266] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these. DESIGN Systematic review. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC. CONCLUSION Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC. PROSPERO REGISTRATION NUMBER 104937.
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Affiliation(s)
- Sophia Liff Maibom
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
- Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
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The PT 2D-Score: a novel tool to predict complications and economic outcome after radical cystectomy. World J Urol 2020; 38:3155-3160. [PMID: 32124017 DOI: 10.1007/s00345-020-03129-8] [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: 09/30/2019] [Accepted: 02/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Radical cystectomy (RC) has a high morbidity and leads to a significant socio-economic burden. We aimed to investigate pre-, intra-, and post-operative variables to create a novel score predicting both post-operative clinical (complications) and economic (length of hospital stay) outcome after RC. METHODS We retrospectively evaluated clinical and histopathological data of 317 patients after RC. We performed univariate and multivariate logistic regression analyses to identify variables associated with post-operative clinical (30-day morbidity according to Clavien-Dindo complications) and economic (length of hospital stay) outcome. RESULTS In multivariate analysis, a high number of intraoperative transfusions (T) of packed red blood cells predicted major complications (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.10-2.58, p = 0.017), preoperative potassium (P) level predicted three or more complications (OR for high preoperative potassium 0.71, 95% CI 0.52-0.98, p = 0.037), and high drain (D) loss on post-operative day 1 predicted a longer hospital stay ≥ 22 days (OR 1.57, 95% CI 1.04-2.35, p = 0.003). The PT2D-Score was able to predict three or more complications (area under the curve: 0.70, 95% CI 0.61-0.78, p < 0.001) and a hospital stay of ≥ 22 days in patients after radical cystectomy (area under the curve: 0.63, 95% confidence interval 0.53-0.72, p = 0.012). CONCLUSIONS The novel PT2D-Score combines preoperative potassium level, intraoperative blood transfusion, and post-operative drain loss to predict both clinical (30-day morbidity) and economic (length of hospital stay) outcome for patients undergoing RC. After validation in a larger cohort, the novel PT2D-Score might serve as an additional criterion to identify patients for intensified monitoring after RC.
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Carrion A, Huguet J, Ribal MJ, Domínguez A, Bonet X, Servián P, Mayordomo O, Ajami T, Picola N, Freixa R, Díaz F, Lozano F, Raventós C, Morote J. Comparison of standard vs. palliative management for bladder cancer in patients older than 85 years: multicenter study of 317 de novo tumors. Urol Oncol 2020; 38:40.e9-40.e15. [DOI: 10.1016/j.urolonc.2019.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/14/2019] [Accepted: 09/04/2019] [Indexed: 12/27/2022]
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Short-term Mortality Associated with Definitive Chemoradiotherapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer. Clin Genitourin Cancer 2019; 17:e1069-e1079. [PMID: 31331865 DOI: 10.1016/j.clgc.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/22/2019] [Accepted: 06/26/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Muscle-invasive bladder cancer (MIBC) may be managed with radical cystectomy (RC) or chemoradiotherapy (CRT). Because patient selection for RC is important to avoid treatment-related mortality, this study addressed a knowledge gap by quantifying short-term mortality with both approaches, as well as predictors thereof. MATERIALS AND METHODS The National Cancer Database was queried (2004-2014) for clinically staged T2-4aN0M0 MIBC that received either CRT or RC. Statistics included cumulative incidence comparisons of 30- and 90-day mortality between patients treated with either CRT or RC and Cox regression to evaluate predictors thereof. RESULTS Of 16,658 patients, 15,208 (91.3%) underwent RC and 1450 (8.7%) CRT. Crude rates of post-treatment mortality at 30 days were 2.7% versus 0.6% (P < .001) and at 90 days were 7.5% versus 4.5% (P = .017) for patients treated with RC and CRT, respectively. When stratifying by age, worse 30- and 90-day mortality with RC was observed for patients aged ≥ 76 years. CONCLUSIONS This study describes 30- and 90-day mortality following RC versus CRT. Both approaches yield statistically similar treatment-related mortality rates in patients ≤ 75 years of age; however, worse post-treatment mortality was observed with use of RC in patients ≥ 76 years of age. These results may be utilized to better inform shared decision-making between patients and providers when weighing both RC and CRT for MIBC.
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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]
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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]
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Schulz GB, Grimm T, Buchner A, Jokisch F, Kretschmer A, Casuscelli J, Ziegelmüller B, Stief CG, Karl A. Surgical High-risk Patients With ASA ≥ 3 Undergoing Radical Cystectomy: Morbidity, Mortality, and Predictors for Major Complications in a High-volume Tertiary Center. Clin Genitourin Cancer 2018; 16:e1141-e1149. [PMID: 30174234 DOI: 10.1016/j.clgc.2018.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate major complications and risk factors for adverse clinical outcome in surgical high-risk (American Society of Anesthesiologists [ASA] 3-4) patients undergoing radical cystectomy (RC) in a high-volume setting. PATIENTS AND METHODS A total of 1206 patients underwent RC between 2004 and 2017 in our institution and were included. We assessed complications graded by the Clavien-Dindo-Classification system (CDC) in addition to the 90-day mortality rate and stratified results by the ASA classification. In a multivariate analysis, risk factors for high-grade complications (CDC ≥ 3) were tested. Additionally, outcome parameters were compared between 2004 to 2010 and 2010 to 2017. RESULTS Patients with ASA ≥ 3 presented with more locally advanced tumors pT ≥ 3 (52.1% vs. 42.4%; P = .002) and positive lymphatic spread N1 (27.2% vs. 23.5%; P = .001) compared with patients with ASA ≤ 2. High-grade complications were significantly (P < .001) more prevalent in patients with ASA ≥ 3 compared with patients with ASA ≤ 2: CDC3 (14.6% vs. 9.4%), CDC4 (10.2% vs. 5.4%), and CDC5 (2.5% vs. 1.0%). The 90-day mortality rate (7.6% vs. 3.2%; P = .002) and perioperative reinterventions (23.5% vs. 13.1%; P < .001) were elevated in patients with ASA ≥ 3. ASA (odds ratio [OR], 2.701, 95% confidence interval [CI], 1.089-6.703; P = .032), previous abdominal operations (OR, 1.683; 95% CI, 1.188-2.384; P = .003), and body mass index ≥ 30 (OR, 1.533; 95% CI, 1.021-2.304; P = .039) proved to function as independent predictors for major complications. CDC ≥ 3 complications (31.7% vs. 24.3%; P = .029) and 90-day mortality (10.4% vs. 5.6%; P = .018) were significantly lower in the second half of the study period. CONCLUSIONS Mortality and morbidity in surgical high-risk patients with ASA 3 to 4 undergoing RC is about twice as high compared with patients with ASA 1 to 2. ASA, previous abdominal operations, and elevated body mass index independently predict adverse clinical outcome in patients with ASA 3 to 4. Our results may help to weigh the surgical risk of RC in multimorbid patients.
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Affiliation(s)
- Gerald B Schulz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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Eredics K, Bretterbauer KM, Comploj E, Friedl A, Gschliesser T, Lenart S, Seklehner S, Wimpissinger F, Madersbacher S. Bladder cancer in nonagenarians: a multicentre study of 123 patients. BJU Int 2018; 122:1010-1015. [PMID: 29804311 DOI: 10.1111/bju.14419] [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: 12/25/2022]
Abstract
OBJECTIVE To investigate the oncological outcome of nonagenarians with bladder cancer, as a substantial rise in bladder cancer in the old-old age group in the upcoming decades is expected, due to demographic changes and the peak incidence around the age of 85 years. The paucity of data of nonagenarians prompted us to investigate the outcomes of such patients. PATIENTS AND METHODS A retrospective, multicentre study was designed to assess patient demographics, tumour patterns, treatment strategies and outcome in patients aged ≥90 years treated at participating centres. Patients entered either as de novo or as recurrent cancer. The study period ranged from 01.01.2006 to 31.12.2016. RESULTS A total of 123 patients with a mean (range) age of 91 (90-99) years were recruited. The American Society of Anesthesiologists Physical Status Classification (ASA-score) distribution was as follows: II, 38%; III, 50%; IV, 12%; and the male to female ratio 2.4:1. The median (range) follow-up was 8 (1-132) months. In all, 60% of patients had a de novo cancer diagnosis. Histological findings revealed: pTa 39% (n = 48), pT1 28.5% (n = 35), and ≥pT2 33% (n = 40). Overall, 67.5% patients had no recurrence, 25.2% one and 7.5% two or more. pTa tumours (n = 48) recurred in 20 patients (42%), pT1 tumours (n = 35) in 12 (34%), and ≥pT2 tumours (n = 40) in six (15%). The median overall survival (OS) was 30.0 months for patients with pTa tumours, 14.0 months for pT1 tumours, and 6.0 months for ≥pT2 tumours. The overall mortality rate of patients with pTa tumours was 40%, with pT1 tumours at 60%, and ≥pT2 tumours 75%. The ASA-score also had a strong influence on median OS after stratification by ASA-score (II, 30 months; III, 12 months; IV, 4 months). CONCLUSIONS In nonagenarians with bladder tumours, pTa/pT1/≥pT2 stages are almost evenly distributed and two-thirds of patients had no recurrence after transurethral resection of the bladder. The mean OS was 1.3 years, and 6 months for ≥pT2 tumours. Further case-series of patients in this specific age-group are required to identify the best management of this increasing proportion of patients with bladder tumours.
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Affiliation(s)
- Klaus Eredics
- Department of Urology, Kaiser-Franz-Josef-Spital, Vienna, Austria
| | | | - Evi Comploj
- Department of Urology, Hospital of Bolzano/Bozen, Bozen, Italy.,Department of Research, College of Health Care Professions Claudiana, Bozen, Italy
| | - Alexander Friedl
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria
| | - Tanja Gschliesser
- Department of Urology, Krankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - Sebastian Lenart
- Department of Urology, Krankenhaus der Barmherzigen Brüder, Vienna, Austria.,Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Stephan Seklehner
- Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.,Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | | | - Stephan Madersbacher
- Department of Urology, Kaiser-Franz-Josef-Spital, Vienna, Austria.,Department of Urology, Sigmund Freud Private University, Vienna, Austria
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Mayr R, Fritsche HM, Zeman F, Reiffen M, Siebertz L, Niessen C, Pycha A, van Rhijn BWG, Burger M, Gierth M. Sarcopenia predicts 90-day mortality and postoperative complications after radical cystectomy for bladder cancer. World J Urol 2018. [DOI: 10.1007/s00345-018-2259-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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Hirobe M, Tanaka T, Shindo T, Ichihara K, Hotta H, Takahashi A, Kato R, Yanase M, Matsukawa M, Itoh N, Kunishima Y, Taguchi K, Horita H, Masumori N. Complications within 90 days after radical cystectomy for bladder cancer: results of a multicenter prospective study in Japan. Int J Clin Oncol 2018; 23:734-741. [PMID: 29442282 DOI: 10.1007/s10147-018-1245-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE We prospectively evaluated the 90-day postoperative mortality and morbidity of open radical cystectomy by using a standardized reporting methodology. Additionally, we assessed the preoperative characteristics to determine risk factors for major complications. METHODS This multicenter prospective study included 185 consecutive patients undergoing open radical cystectomy from October 2010 through March 2014. Postoperative complications within 90 days were recorded and graded according to the modified Clavien-Dindo classification. RESULTS Totally, 328 postoperative complications were observed in 149 patients (80.5%). Of these events, 73 (22.2%) were high grade (≥ Grade III), and developed in 46 patients (24.9%). Three patients (1.6%) died postoperatively. Urinary tract infection, wound complications, and paralytic ileus were common complications that occurred in 55 (29.7%), 42 (22.7%) and 41 (22.2%) patients, respectively. Ureteroenteric stricture was diagnosed in 13 of the 151 patients (8.6%) undergoing intestinal urinary diversion. Emergency room visits were required for 13 patients (7.0%) and readmission after discharge was needed for 36 (19.5%). A body mass index ≥ 25 kg/m2, smoking history and Charlson Comorbidity Index ≥ 2 were independent risk factors for high-grade complications, and their odds ratios (95% confidence intervals) were 2.357 (1.123-4.948), 2.843 (1.225-6.596) and 3.025 (1.390-6.596), respectively. CONCLUSIONS Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.
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Affiliation(s)
- Megumi Hirobe
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Koji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Hiroshi Hotta
- Division of Urology, Asahikawa Red Cross Hospital, Asahikawa, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Atsushi Takahashi
- Division of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Ryuichi Kato
- Division of Urology, Muroran City General Hospital, Muroran, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Masahiro Yanase
- Division of Urology, Sunagawa City Medical Center, Sunagawa, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Masanori Matsukawa
- Division of Urology, Takikawa Municipal Hospital, Takikawa, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Naoki Itoh
- Division of Urology, NTT-East Corporation Sapporo Medical Center, Sapporo, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Yasuharu Kunishima
- Division of Urology, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Keisuke Taguchi
- Division of Urology, Oji General Hospital, Tomakomai, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Hiroki Horita
- Division of Urology, Hokkaido Saiseikai Otaru Hospital, Otaru, Japan.,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan. .,Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan.
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15
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Park J, Jeong H. Morbidity, Mortality, and Survival for Radical Cystectomy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Muto S, Kitamura K, Ieda T, Shimizu F, Nagata M, Isotani S, Ide H, Yamaguchi R, Horie S. A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: Initial experience. Investig Clin Urol 2017; 58:171-178. [PMID: 28480342 PMCID: PMC5419105 DOI: 10.4111/icu.2017.58.3.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/16/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Robot-assisted radical cystectomy (RARC) was originally intended to replace open radical cystectomy (ORC) as a minimally invasive surgery for patients with invasive bladder cancer. The purpose of this study was to evaluate the advantages of robotic surgery, comparing perioperative and oncologic outcomes between RARC and ORC. MATERIALS AND METHODS Between June 2012 and August 2016, 49 bladder cancer patients were given a radical cystectomy, 21 robotically and 28 by open procedure. We compared the clinical variables between the RARC and ORC groups. RESULTS In the RARC group, the median estimated blood loss (EBL) during cystectomy, total EBL, operative time during cystectomy, and total operative time were 0 mL, 457.5 mL, 199 minutes, and 561 minutes, respectively. EBL during cystectomy (p<0.001), total EBL (p<0.001), and operative time during cystectomy (p=0.003) in the RARC group were significantly lower compared with the ORC group. Time to resumption of a regular diet (p<0.001) and length of stay (p=0.017) were also significantly shorter compared with the ORC group. However, total operative time in the RARC group (median, 561 minutes) was significantly longer compared with the ORC group (median, 492.5 minutes; p=0.015). CONCLUSIONS This Japanese study presented evidence that RARC yields benefits in terms of BL and time to regular diet, while consuming greater total operative time. RARC may be a minimally invasive surgical alternative to ORC with less EBL and shorter length of stay.
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Affiliation(s)
- Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kousuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Ieda
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Raizo Yamaguchi
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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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.
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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
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