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Yanjun Z, Jin S, Qiuyue L, Tao L. Risk factors and the establishment of nomogram model for incisional-wound infection in patients with bladder cancer after radical resection. Asian J Surg 2023; 46:1418-1419. [PMID: 36167658 DOI: 10.1016/j.asjsur.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/04/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Zhou Yanjun
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Sima Jin
- Key Laboratory of Oncogenesis and Related Genes Research, Aerospace Clinical Medical College of Peking University, No. 15 Yuquan Road, Beijing, 100049, China
| | - Li Qiuyue
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Liang Tao
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, 100730, Beijing, China.
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Wayan Y, Ayu PD, Gde OAA, Wayan N, Widyadharma IPE. Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016. Open Access Maced J Med Sci 2018; 6:1647-1651. [PMID: 30337981 PMCID: PMC6182542 DOI: 10.3889/oamjms.2018.384] [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: 07/29/2018] [Revised: 09/08/2018] [Accepted: 09/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year’s survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.
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Affiliation(s)
- Yudiana Wayan
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - Pratiwi Dinar Ayu
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - Oka A A Gde
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - Niryana Wayan
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - I Putu Eka Widyadharma
- Department of Neurology, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
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Effects of Nonsteroidal Anti-Inflammatory Drugs as Patient Controlled Analgesia on Early Bowel Function Recovery after Radical Cystectomy. Sci Rep 2018; 8:4658. [PMID: 29545530 PMCID: PMC5854570 DOI: 10.1038/s41598-018-22677-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023] Open
Abstract
This study aimed to evaluate the effects of ketorolac, a commonly used non-steroidal anti-inflammatory drug (NSAID) as patient controlled intravenous infusion analgesia (PCIA) for the patients underwent radical cystectomy (RC) due to bladder cancer regarding post-operational indices of recovery. Total seventy patients who underwent radical cystectomy for the treatment of bladder cancer were included in the study. 35 patients received ketorolac as PCIA (NSAIDS group) and 35 patients had morphine infusion as PCIA (morphine group). Pain intensity, bowel function recovery and length of hospital stay were evaluated. Early postoperative complications were analyzed according to surgical types (robot RC vs. open RC). Demographics were similar between two groups. NSAIDS group showed a significant reduction in postoperative vomiting (p = 0.001), time to flatus (p = 0.028), time to first bowel movement (p = 0.001) and time to first clear liquid diet (p = 0.002) compared with morphine group. No statistically significant differences were observed between two groups regarding length of hospitalization, and postoperative complications. For 48 hours after RC, pain relief was slightly better in morphine group (p < 0.001). Both open RC and robot RC cases showed significantly better bowel function recovery with NSAIDS groups. Ketorolac as PCIA is relatively effective in pain management with better gastrointestinal recovery after RC.
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Izquierdo L, Peri L, Leon P, Ramírez-Backhaus M, Manning T, Alcaraz A, Roupret M, Solsona E, Rubio J, Sengupta S, Chan Y, Liodakis P, Gyomber D, Bolton D, Lawrentschuk N. The role of cystectomy in elderly patients - a multicentre analysis. BJU Int 2015; 116 Suppl 3:73-9. [PMID: 26333289 DOI: 10.1111/bju.13227] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. OBJECTIVE To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. PATIENTS AND METHODS A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. RESULTS A total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. CONCLUSION Radical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri-modality therapy need to be considered within a multi-disciplinary approach. More data is required to determine which sub-groups of elderly patients would benefit from a complication, survival and quality of life perspective.
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Affiliation(s)
| | - Lluis Peri
- Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Priscila Leon
- Department of Urology, La Pitié-Salpetrière Hospital, Paris, France
| | | | - Thomas Manning
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia
| | | | - Morgan Roupret
- Department of Urology, La Pitié-Salpetrière Hospital, Paris, France.,Department of Urology, Fundación IVO, Valencia, Spain
| | | | - Jose Rubio
- Department of Urology, Fundación IVO, Valencia, Spain
| | - Shomik Sengupta
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia
| | - Yee Chan
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia
| | - Peter Liodakis
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia
| | - Dennis Gyomber
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia
| | - Damien Bolton
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Austin Hospital, Heidelberg, Vic., Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
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Léon P, Seisen T, Rouprêt M. Surgical landscape of radical cystectomy for bladder cancer in France over the last 10 years. World J Urol 2014; 33:889-90. [PMID: 24973047 DOI: 10.1007/s00345-014-1352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Priscilla Léon
- Academic Department of Urology of La Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, 47-83 bvd de l'Hôpital, 75013, Paris, France
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Abstract
A systematic review of the literature on perioperative morbidity (POM) was done using Medline software with a combination of keywords like mortality, morbidity, and complications. In addition, we review the analysis of our hospital data of 261 Radical cystectomies (RCs) performed in an 11-year period and our latest clinical pathway for RC. Age range in our series was 50 to 81 years with 240 males and 21 females. RCs were performed by intraperitoneal method in 172 patients and by our extraperitoneal (EP) method in 89 patients. Urinary diversion was ileal conduit in 159 patients and neobladder in 102 patients. Blood loss ranged between 500 and 1500 ccs. Postoperative mortality occurred in eight patients (3%). Among the other early post-op complications, major urinary leak was seen in nine and minor in 11, requiring PCN in five patients and reoperation in four patients. Bowel leak or obstruction was seen in six and four patients, respectively, requiring reoperation in six patients. EP RC in our series showed some benefit in reduction of POM. The mortality of RC has declined but the POM still ranges from 11 to 68%, as reported in 23 series (1999-2008) comprising of 14 076 patients. Various risk factors leading to POM and some corrective measures are discussed in detail. However, most of these series are retrospective and lack standard complication reporting, which limits the comparison of outcomes. Various modifications in open surgical technique and laparoscopic and Robotic approaches are aimed at reduction in mortality and POM of RC.
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Affiliation(s)
- Jagdeesh N Kulkarni
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, India
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Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, Wirth MP. Prevention and Management of Complications Following Radical Cystectomy for Bladder Cancer. Eur Urol 2010; 57:983-1001. [DOI: 10.1016/j.eururo.2010.02.024] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/17/2010] [Indexed: 01/11/2023]
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