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Wong CHM, Ko ICH, Kang SH, Kitamura K, Horie S, Muto S, Ohyama C, Hatakeyama S, Patel M, Yang CK, Kijvikai K, Youl LJ, Chen HG, Zhang RY, Lin TX, Lee LS, Teoh JYC, Chan E. Long-Term Outcomes of Orthotopic Neobladder Versus Ileal Conduit Urinary Diversion in Robot-Assisted Radical Cystectomy (RARC): Multicenter Results from the Asian RARC Consortium. Ann Surg Oncol 2024; 31:5785-5793. [PMID: 38802711 PMCID: PMC11300606 DOI: 10.1245/s10434-024-15396-5] [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: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Robot-assisted radical cystectomy (RARC) has gained traction in the management of muscle invasive bladder cancer. Urinary diversion for RARC was achieved with orthotopic neobladder and ileal conduit. Evidence on the optimal method of urinary diversion was limited. Long-term outcomes were not reported before. This study was designed to compare the perioperative and oncological outcomes of ileal conduit versus orthotopic neobladder cases of nonmetastatic bladder cancer treated with RARC. PATIENTS AND METHODS The Asian RARC consortium was a multicenter registry involving nine Asian centers. Consecutive patients receiving RARC were included. Cases were divided into the ileal conduit and neobladder groups. Background characteristics, operative details, perioperative outcomes, recurrence information, and survival outcomes were reviewed and compared. Primary outcomes include disease-free and overall survival. Secondary outcomes were perioperative results. Multivariate regression analyses were performed. RESULTS From 2007 to 2020, 521 patients who underwent radical cystectomy were analyzed. Overall, 314 (60.3%) had ileal conduit and 207 (39.7%) had neobladder. The use of neobladder was found to be protective in terms of disease-free survival [Hazard ratio (HR) = 0.870, p = 0.037] and overall survival (HR = 0.670, p = 0.044) compared with ileal conduit. The difference became statistically nonsignificant after being adjusted in multivariate cox-regression analysis. Moreover, neobladder reconstruction was not associated with increased blood loss, nor additional risk of major complications. CONCLUSIONS Orthotopic neobladder urinary diversion is not inferior to ileal conduit in terms of perioperative safety profile and long-term oncological outcomes. Further prospective studies are warranted for further investigation.
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Affiliation(s)
- Chris Ho-Ming Wong
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ivan Ching-Ho Ko
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kousuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University, Hirosaki, Japan
| | | | - Manish Patel
- Department of Urology, The University of Sydney, Sydney, Australia
| | - Cheung-Kuang Yang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kittinut Kijvikai
- Department of Urology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand
| | - Lee Ji Youl
- Department of Urology, Catholic University of Korea, Seoul, Republic of Korea
| | - Hai-Ge Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rui-Yun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tian-Xin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Eddie Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
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2
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Pellegrino F, Martini A, Falagario UG, Rautiola J, Russo A, Mertens LS, Di Gianfrancesco L, Bravi CA, Vollemaere J, Abdeen M, Moschini M, Mendrek M, Kjøbli E, Buse S, Wijburg C, Touzani A, Ploussard G, Antonelli A, Schwenk L, Ebbing J, Vasdev N, Froelicher G, John H, Canda AE, Balbay MD, Stoll M, Edeling S, Berquin C, Van Praet C, Leyh-Bannurah SR, Siemer S, Stoeckle M, Mottrie A, D'Hondt F, Crestani A, Porreca A, Briganti A, Montorsi F, van der Poel H, Dacaestecker K, Gaston R, Hosseini A, Wiklund NP. How can we reduce morbidity after robot-assisted radical cystectomy with intracorporeal neobladder? A report on postoperative complications by the European Association of Urology Robotic Urology Section Scientific Working Group. BJU Int 2024; 133:673-677. [PMID: 38511350 DOI: 10.1111/bju.16283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Francesco Pellegrino
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Alberto Martini
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | - Ugo Giovanni Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Juhana Rautiola
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Antonio Russo
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laura S Mertens
- Oncological Urology, IRCCS Veneto Institute of Oncology, Padua, Italy
| | | | - Carlo Andrea Bravi
- Orsi Academy, Ghent, Belgium
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Jonathan Vollemaere
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Muhammad Abdeen
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Marco Moschini
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Mikolaj Mendrek
- Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Kjøbli
- Department of Urology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Stephan Buse
- Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carl Wijburg
- Department of Urology, International Center of Oncology, Casablanca, Morocco
| | - Alae Touzani
- Department of Urology, University of Verona, Verona, Italy
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | - Guillaume Ploussard
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | | | - Laura Schwenk
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK
| | - Jan Ebbing
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Department of Urology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Gabriel Froelicher
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Hubert John
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Abdullah Erdem Canda
- RMK AIMES (Rahmi M. Koç Academy of Interventional Medicine, Education and Simulation), Istanbul, Turkey
- Department of Urology, American Hospital, Istanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, Vinzenz Hospital, Hannover, Germany
- RMK AIMES (Rahmi M. Koç Academy of Interventional Medicine, Education and Simulation), Istanbul, Turkey
| | - Marcel Stoll
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Camille Berquin
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Charles Van Praet
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Stefan Siemer
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Michael Stoeckle
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Alexander Mottrie
- Orsi Academy, Ghent, Belgium
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Frederiek D'Hondt
- Orsi Academy, Ghent, Belgium
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Hendrik van der Poel
- Oncological Urology, IRCCS Veneto Institute of Oncology, Padua, Italy
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Karel Dacaestecker
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard Gaston
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Abolfazl Hosseini
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - N Peter Wiklund
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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3
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Pellegrino F, Leni R, Basile G, Rosiello G, Re C, Scilipoti P, De Angelis M, Longoni M, Avesani G, Quarta L, Zaurito P, Cattafi F, Burgio G, Gandaglia G, Montorsi F, Briganti A, Moschini M. Peri- and post-operative outcomes of robot-assisted radical cystectomy after the implementation of the EAU guidelines recommendations for collecting and reporting complications at a high-volume referral center. World J Urol 2024; 42:270. [PMID: 38679650 DOI: 10.1007/s00345-024-04970-x] [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: 01/24/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE No studies relied on a standardized methodology to collect postoperative complications after robot-assisted radical cystectomy (RARC). The aim of our study was to evaluate peri- and post-operative outcomes of patients undergoing RARC adhering to the European Association of Urology (EAU) recommendations for reporting surgical outcomes and using a long postoperative follow-up. MATERIALS AND METHODS 246 patients who underwent RARC with intracorporal urinary diversion at a single tertiary referral center with a postoperative follow-up ≥ 1 year for survivors. Postoperative outcomes were collected prospectively by interviews done by medical doctors. Complications were scored using the Clavien-Dindo classification (CD), grouped by type and severity (severe: CD score ≥ 3). We described peri- and post-operative outcomes and complication chronological distribution. RESULTS Overall, 16 (6.5%) and 225 patients (91%) experienced intraoperative and postoperative complications, respectively. Moreover, 139 (57%) experienced severe complications. The most common any-grade and severe complications were infectious (72%) and genitourinary (35%), respectively. Overall, 52% of complications (358/682) occurred within 10 days from surgery, and 51% of severe complications (106/207) occurred within 35 days. However, 13% of complications (90/682) and 28% of severe complications (59/207) occurred 3 months after surgery. The earliest complications were fever of unknown origins and paralytic ileus (median time-to-complication [mTTC]: 4 days), the latest complications were urinary tract infection (mTTC: 40 days) and hydronephrosis/ureteral obstruction (mTTC: 70 days). CONCLUSIONS The rate of postoperative complications after RARC is > 90% when a standardized collection method and a long follow-up is implemented. These results should be used to identify potential areas of improvement and for preoperative patient counseling.
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Affiliation(s)
- Franceso Pellegrino
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Riccardo Leni
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Scilipoti
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattia Longoni
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Avesani
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Quarta
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Zaurito
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Cattafi
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giusy Burgio
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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4
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Piramide F, Turri F, Amparore D, Fallara G, De Groote R, Knipper S, Wuernschimmel C, Bravi CA, Lambert E, Di Maida F, Liakos N, Pellegrino F, Andras I, Mastrorosa A, Tillu N, Mastroianni R, Paciotti M, Wenzel M, Bianchi R, di Trapani E, Moschovas MC, Gandaglia G, Moschini M, D'Hondt F, Rocco B, Fiori C, Galfano A, Minervini A, Simone G, Briganti A, De Cobelli O, Gaston R, Montorsi F, Breda A, Wiklund P, Porpiglia F, Mottrie A, Larcher A, Dell'Oglio P. Atlas of Intracorporeal Orthotopic Neobladder Techniques After Robot-assisted Radical Cystectomy and Systematic Review of Clinical Outcomes. Eur Urol 2024; 85:348-360. [PMID: 38044179 DOI: 10.1016/j.eururo.2023.11.017] [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: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple and heterogeneous techniques have been described for orthotopic neobladder (ONB) reconstruction after robot-assisted radical cystectomy. Nonetheless, a systematic assessment of all the available options is lacking. OBJECTIVE To provide the first comprehensive step-by-step description of all the available techniques for robotic intracorporeal ONB together with individual intraoperative, perioperative and functional outcomes based on a systematic review of the literature. DESIGN, SETTING, AND PARTICIPANTS We performed a systematic review of the literature, and MEDLINE/PubMed, Embase, Scopus, and Web of Science databases were searched to identify original articles describing different robotic intracorporeal ONB techniques and reporting intra- and perioperative outcomes. Studies were categorized according to ONB type, providing a synthesis of the current evidence. Video material was provided by experts in the field to illustrate the surgical technique of each intracorporeal ONB. SURGICAL PROCEDURE Nine different ONB types were identified: Studer, Hautmann, Y shape, U shape, Bordeaux, Pyramid, Shell, Florence Robotic Intracorporeal Neobladder, and Padua Ileal Neobladder. MEASUREMENTS Continuous and categorical variables are presented as mean ± standard deviation and as frequencies and proportions, respectively. RESULTS AND LIMITATIONS Of 2587 studies identified, 19 met our inclusion criteria. No cohort studies or randomized control trials comparing different neobladder types are available. Available techniques for intracorporeal robotic ONB reconstruction have similar operative time, estimated blood loss, intraoperative complications, and length of stay. Major variability exists concerning postoperative complications and functional outcomes, likely related to reporting bias. CONCLUSIONS Several techniques are described for intracorporeal ONB during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted ONB reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. PATIENT SUMMARY Patients elected for radical cystectomy should be aware that multiple techniques for robotic orthotopic neobladder are available, but that current evidence does not favor one type over the others.
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Affiliation(s)
- Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Fallara
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Sophie Knipper
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Edward Lambert
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Nikolaos Liakos
- Department of Urology, Medical Faculty and Medical Centre of the University of Freiburg, Freiburg, Germany
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandro Mastrorosa
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France; Urology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Neeraja Tillu
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco Paciotti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Bernando Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Breda
- Department of Urology, Universitat Autònoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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5
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von Deimling M, Rink M, Klemm J, Koelker M, Schuettfort V, König F, Gild P, Ludwig TA, Marks P, Dahlem R, Fisch M, Shariat SF, Vetterlein MW. Comprehensive Evaluation of the Ability of Comorbidity and Health Status Indices to Improve the Prediction of Perioperative Morbidity and Long-Term Survival Outcomes After Radical Cystectomy. Clin Genitourin Cancer 2024; 22:336-346.e9. [PMID: 38199879 DOI: 10.1016/j.clgc.2023.12.002] [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: 09/01/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND In the era of standardized outcome reporting, it remains unclear if widely used comorbidity and health status indices can enhance predictive accuracy for morbidity and long-term survival outcomes after radical cystectomy (RC). PATIENTS AND METHODS In this monocentric study, we included 468 patients undergoing open RC with pelvic lymph node dissection for bladder cancer between January 2009 and December 2017. Postoperative complications were meticulously assessed according to the EAU guideline criteria for standardized outcome reporting. Multivariable regression models were fitted to evaluate the ability of ASA physical status (ASA PS), Charlson comorbidity index (± age-adjustment) and the combination of both to improve prediction of (A) 30-day morbidity key estimates (major complications, readmission, and cumulative morbidity as measured by the Comprehensive Complication index [CCI]) and (B) secondary mortality endpoints (overall [OM], cancer-specific [CSM], and other-cause mortality [OCM]). RESULTS Overall, 465 (99%) and 52 (11%) patients experienced 30-day complications and major complications (Clavien-Dindo grade ≥IIIb), respectively. Thirty-seven (7.9%) were readmitted within 30 days after discharge. Comorbidity and health status indices did not improve the predictive accuracy for 30-day major complications and 30-day readmission of a reference model but were associated with 30-day CCI (all P < .05). When ASA PS and age-adjusted Charlson index were combined, ASA PS was no longer associated with 30-day CCI (P = .1). At a median follow-up of 56 months (IQR 37-86), OM, CSM, and 90-day mortality were 37%, 24%, and 2.9%, respectively. Both Charlson and age-adjusted Charlson index accurately predicted OCM (all P < .001) and OM (all P ≤ .002) but not CSM (all P ≥ .4) and 90-day mortality (all P > .05). ASA PS was not associated with oncologic outcomes (all P ≥ .05). CONCLUSION While comorbidity and health status indices have a role in predicting OCM and OM after RC, their importance in predicting postoperative morbidity is limited. Especially ASA PS performed poorly. This highlights the need for procedure-specific comorbidity assessment rather than generic indices.
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Affiliation(s)
- Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Koelker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor Schuettfort
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik König
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Bravi CA, Balestrazzi E, De Loof M, Rebuffo S, Piramide F, Mottaran A, Paciotti M, Sorce G, Nocera L, Sarchi L, Peraire M, Colla'-Ruvolo C, Frego N, Piro A, Ticonosco M, De Backer P, Farinha R, Van Den Bossche H, De Naeyer G, D'Hondt F, De Groote R, Mottrie A. Robot-assisted Radical Prostatectomy Performed with Different Robotic Platforms: First Comparative Evidence Between Da Vinci and HUGO Robot-assisted Surgery Robots. Eur Urol Focus 2024; 10:107-114. [PMID: 37634969 DOI: 10.1016/j.euf.2023.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/22/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In the field of robotic surgery, there is a lack of comparative evidence on surgical and functional outcomes of different robotic platforms. OBJECTIVE To assess the outcomes of patients receiving robot-assisted radical prostatectomy (RARP) at a high-volume robotic center with daVinci and HUGO robot-assisted surgery (RAS) surgical systems. DESIGN, SETTING, AND PARTICIPANTS We analyzed the data of 542 patients undergoing RARP ± extended pelvic lymph node dissection at OLV hospital (Aalst, Belgium) between 2021 and 2023. All procedures were performed by six surgeons using daVinci or HUGO RAS robots; the use of one platform rather than the other did not follow any specific preference and/or indication. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable analyses investigated the association between robotic system (daVinci vs HUGO RAS) and surgical outcomes after adjustment for patient- and tumor-related factors. Urinary continence recovery was defined as the use of no/one safety pad. RESULTS AND LIMITATIONS A total of 378 (70%) and 164 (30%) patients underwent RARP with daVinci and HUGO RAS surgical systems, respectively. Despite a higher rate of palpable disease in the HUGO RAS group (34% vs 25%), baseline characteristics did not differ between the groups (all p > 0.05). After adjusting for confounders, we did not find evidence of a difference between the groups with respect to operative time (estimate: 16.71; 95% confidence interval [CI]: -6.35, 39.78; p = 0.12), estimated blood loss (estimate: 3.12; 95% CI: -67.03, 73.27; p = 0.9), and postoperative Clavien-Dindo ≥2 complications (odds ratio [OR]: 1.66; 95% CI: 0.34, 8.15; p = 0.5). On final pathology, 55 (15%) and 20 (12%) men in, respectively, the daVinci and the HUGO RAS group had positive surgical margins (PSMs; p = 0.5). On multivariable analyses, we did not find evidence of an association between a robotic system and PSMs (OR: 1.08; 95% CI: 0.56, 2.07; p = 0.8). Similarly, the odds of recovering continence did not differ between daVinci and HUGO RAS cases after both 1 mo (OR: 0.78; 95% CI: 0.45, 1.38; p = 0.4) and 3 mo (OR: 1.17; 95% CI: 0.49, 2.79; p = 0.7). CONCLUSIONS Among patients receiving RARP with daVinci or HUGO RAS surgical platforms, we did not find differences in surgical and functional outcomes between the robots. This may be a result of a standardized surgical technique that allowed surgeons to transfer their skills between robotic systems. Awaiting future investigations with longer follow-up, these results have important implications for patients, surgeons, and health care policymakers. PATIENT SUMMARY We compared surgical and functional outcomes of patients receiving robot-assisted radical prostatectomy with daVinci versus HUGO robot-assisted surgery (RAS) robots. The two platforms were able to achieve similar outcomes, suggesting that the introduction of HUGO RAS is safe and allows for optimal outcomes after radical prostatectomy.
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Affiliation(s)
- Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manon De Loof
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Silvia Rebuffo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Federico Piramide
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Angelo Mottaran
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Gabriele Sorce
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Nocera
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Maria Peraire
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Claudia Colla'-Ruvolo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Nicola Frego
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pieter De Backer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Hannes Van Den Bossche
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Department of Urology, General Hospital West, Veurne, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
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7
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Dell'Oglio P, Tappero S, Panunzio A, Antonelli A, Salvador D, Xylinas E, Alvarez-Maestro M, Hurle R, Salas RS, Colomer A, Simone G, Hendricksen K, Peroni A, Lonati C, Olivero A, Rouprêt M, Roumiguié M, Soria F, Umari P, D'Andrea D, Terrone C, Galfano A, Moschini M, Trapani ED. Age represents the main driver of surgical decision making in patients candidate to radical cystectomy. J Surg Oncol 2023. [PMID: 37126407 DOI: 10.1002/jso.27255] [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: 12/20/2022] [Revised: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Age might influence the choice of surgical approach, type of urinary diversion (UD) and lymph node dissection (LND) in patients candidate to radical cystectomy (RC) for urothelial bladder cancer (UBC). Similarly, age may enhance surgical morbidity and worsen perioperative outcomes. We tested the impact of age (octogenarian vs. younger patients) on surgical decision making and peri- and postoperative outcomes of RC. METHODS Non-metastatic muscle-invasive UBC patients treated with RC at 18 high-volume European institutions between 2006 and 2021 were identified and stratified according to age (≥80 vs. <80 years). Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology guidelines recommendations were accomplished in collection and reporting of, respectively, intraoperative and postoperative complications. Multivariable logistic regression models (MVA) tested the impact of age on outcomes of interest. Sensitivity analyses after 1:3 propensity score matching were performed. RESULTS Of 1955 overall patients, 251 (13%) were ≥80-year-old. Minimally invasive RC was performed in 18% and 40% of octogenarian and younger patients, respectively (p < 0.001). UD without bowel manipulation (ureterocutaneostomy, UCS) was performed in 31% and 7% of octogenarian and younger patients (p < 0.001). LND was delivered to 81% and 93% of octogenarian and younger patients (p < 0.001). At MVA, age ≥80 years independently predicted open approach (odds ratio [OR]: 1.55), UCS (OR: 3.70), and omission of LND (OR: 0.41; all p ≤ 0.02). Compared to their younger counterparts, octogenarian patients experienced higher rates of intraoperative (8% vs. 4%, p = 0.04) but not of postoperative complications (64% vs. 61%, p = 0.07). At MVA, age ≥80 years was not an independent predictor of length of stay, intraoperative or postoperative transfusions and complications, and readmissions (all p values >0.1). These results were replicated in sensitivity analyses. CONCLUSIONS Age ≥80 years does not independently portend worse surgical outcomes for RC. However, octogenarians are unreasonably more likely to receive open approach and UCS diversion, and less likely to undergo LND.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefano Tappero
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Andrea Panunzio
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Daniel Salvador
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Evanguelos Xylinas
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | | | - Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy
| | | | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Angelo Peroni
- Department of Urology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Lonati
- Department of Urology, ASST Spedali Civili, Brescia, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Morgan Rouprêt
- Department of Urology, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Sorbonne, Paris, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, Oncopole, Toulouse, France
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, Torino School of Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Moschini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ettore Di Trapani
- Division of Urology, IEO-European Institute of Oncology, IRCCS, Milan, Italy
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8
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Sholklapper TN, Ballon J, Sayegh AS, La Riva A, Perez LC, Huang S, Eppler M, Nelson G, Marchegiani G, Hinchliffe R, Gordini L, Furrer M, Brenner MJ, Dell-Kuster S, Biyani CS, Francis N, Kaafarani HM, Siepe M, Winter D, Sosa JA, Bandello F, Siemens R, Walz J, Briganti A, Gratzke C, Abreu AL, Desai MM, Sotelo R, Agha R, Lillemoe KD, Wexner S, Collins GS, Gill I, Cacciamani GE. Bibliometric analysis of academic journal recommendations and requirements for surgical and anesthesiologic adverse events reporting. Int J Surg 2023; 109:1489-1496. [PMID: 37132189 PMCID: PMC10389352 DOI: 10.1097/js9.0000000000000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/31/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Standards for reporting surgical adverse events (AEs) vary widely within the scientific literature. Failure to adequately capture AEs hinders efforts to measure the safety of healthcare delivery and improve the quality of care. The aim of the present study is to assess the prevalence and typology of perioperative AE reporting guidelines among surgery and anesthesiology journals. MATERIALS AND METHODS In November 2021, three independent reviewers queried journal lists from the SCImago Journal & Country Rank (SJR) portal (www.scimagojr.com), a bibliometric indicator database for surgery and anesthesiology academic journals. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. Quartile 1 (Q1) was considered the top quartile and Q4 bottom quartile based on the journal impact factor. Journal author guidelines were collected to determine whether AE reporting recommendations were included and, if so, the preferred reporting procedures. RESULTS Of 1409 journals queried, 655 (46.5%) recommended surgical AE reporting. Journals most likely to recommend AE reporting were: by category surgery (59.1%), urology (53.3%), and anesthesia (52.3%); in top SJR quartiles (i.e. more influential); by region, based in Western Europe (49.8%), North America (49.3%), and the Middle East (48.3%). CONCLUSIONS Surgery and anesthesiology journals do not consistently require or provide recommendations on perioperative AE reporting. Journal guidelines regarding AE reporting should be standardized and are needed to improve the quality of surgical AE reporting with the ultimate goal of improving patient morbidity and mortality.
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Affiliation(s)
- Tamir N. Sholklapper
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jorge Ballon
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Aref S. Sayegh
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Anibal La Riva
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Laura C. Perez
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sherry Huang
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Michael Eppler
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | | | - Luca Gordini
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome
| | - Marc Furrer
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London
- Department of Urology, University of Bern, Inselspital, Bern
| | - Michael J. Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Salome Dell-Kuster
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy; University Hospital Basel, Switzerland
| | | | - Nader Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil
| | | | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital, Bern
| | - Des Winter
- Center for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Julie A. Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Robert Siemens
- Department of Urology, Queen’s University, Kingston, Ontario, Canada
| | - Jochen Walz
- Department of Urology, Intitut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele
- University Vita-Salute San Raffaele, Milan
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andre L. Abreu
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Mihir M. Desai
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Rene Sotelo
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | | | - Keith D. Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA, USA
| | - Steven Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Gary S. Collins
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Inderbir Gill
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Giovanni E. Cacciamani
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
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9
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Tappero S, Dell'Oglio P, Cerruto MA, Sanchez Salas R, Buisan Rueda O, Simone G, Hendricksen K, Soria F, Umari P, Antonelli A, Briganti A, Montorsi F, de Cobelli O, Terrone C, Galfano A, Moschini M, Di Trapani E. Ileal Conduit Versus Orthotopic Neobladder Urinary Diversion in Robot-assisted Radical Cystectomy: Results from a Multi-institutional Series. EUR UROL SUPPL 2023; 50:47-56. [PMID: 37101775 PMCID: PMC10123439 DOI: 10.1016/j.euros.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
Background Head-to-head comparisons between ileal conduit (IC) and orthotopic neobladder (ONB) in terms of peri- and postoperative outcomes and complications, in the specific setting of robot-assisted radical cystectomy (RARC), are not available. Objective To address the impact of the type of urinary diversion (UD, IC vs ONB) on RARC morbidity, as well as operative time (OT), length of stay (LOS), and readmissions. Design setting and participants Urothelial bladder cancer patients treated with RARC at nine high-volume European institutions between 2008 and 2020 were identified. Intervention RARC with either IC or ONB. Outcome measurements and statistical analysis Intra- and postoperative complications were collected and reported according to the Intraoperative Complications Assessment and Reporting with Universal Standards recommendations and European Association of Urology guidelines, respectively. Multivariable logistic regression models tested the impact of UD on outcomes, after adjustment for clustering at single hospital level. Results and limitations Overall, 555 nonmetastatic RARC patients were identified. In 280 (51%) and 275 (49%) patients, an IC and an ONB were performed, respectively. Eighteen intraoperative complications were recorded. The rates of intraoperative complications were 4% in IC patients and 3% in ONB patients (p = 0.4). The median LOS and readmission rates were 10 versus 12 d (p < 0.001) and 20% versus 21% (p = 0.8) in IC versus ONB patients, respectively. At a multivariable logistic regression analyses, the type of UD (IC vs ONB) reached the independent predictor status for prolonged OT (odds ratio [OR]: 0.61, p = 0.03) and prolonged LOS (OR: 0.34, p < 0.001), but not for readmission (OR: 0.92, p = 0.7). Overall, 513 postoperative complications were experienced by 324 patients (58%). At least one postoperative complication was experienced by 160 (57%) IC patients versus 164 (60%) ONB patients (p = 0.6). The type of UD reached the status of an independent predictor of UD-related complications (OR: 0.64, p = 0.03). Conclusions Compared with RARC with ONB, RARC with IC is less prone to UD-related postoperative complications, prolonged OT, and prolonged LOS. Patient summary To date, the impact of the type of urinary diversion, namely, ileal conduit versus orthotopic neobladder, on peri- and postoperative outcomes of robot-assisted radical cystectomy is unknown. Based on a rigorous data accrual, which relied on established complication reporting systems (Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology recommended systems), we reported intra- and postoperative complications according to urinary diversion type. Moreover, we found that ileal conduit was associated with lower operative time and length of stay, and yielded a protective effect in terms of urinary diversion-related complications.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Corresponding author. Department of Urology, IRCCS Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. Tel. +39 3287132369, +39 0105553935.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology IRCCS, Milan, Italy
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10
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Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-analysis. World J Surg 2023; 47:962-974. [PMID: 36709215 DOI: 10.1007/s00268-022-06882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to systematically evaluate perioperative adverse events (AEs) in patients undergoing ILND and its reporting. METHODS A systematic review was conducted according to PRISMA. PubMed, MEDLINE, Scopus, and Embase were queried to identify studies discussing perioperative AEs in patients with melanoma, penile, and vulvar cancer following ILND. RESULTS Our search generated 3.469 publications, with 296 studies meeting the inclusion criteria. Details of 14.421 patients were analyzed. Of these studies, 58 (19.5%) described intraoperative AEs (iAEs) as an outcome of interest. Overall, 68 (2.9%) patients reported at least one iAE. Postoperative AEs were reported in 278 studies, combining data on 10.898 patients. Overall, 5.748 (52.7%) patients documented ≥1 postoperative AEs. The most reported ILND-related AEs were lymphatic AEs, with a total of 4.055 (38.8%) events. The pooled meta-analysis confirmed that high BMI (RR 1.09; p = 0.006), ≥1 comorbidities (RR 1.79; p = 0.01), and diabetes (RR 1.81; p = < 0.00001) are independent predictors for any AEs after ILND. When assessing the quality of the AEs reporting, we found 25% of studies reported at least 50% of the required criteria. CONCLUSION ILND performed in melanoma, penile, and vulvar cancer patients is a morbid procedure. The quality of the AEs reporting is suboptimal. A more standardized AEs reporting system is needed to produce comparable data across studies for furthering the development of strategies to decrease AEs.
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Soliman C, Sathianathen NJ, Thomas BC, Giannarini G, Lawrentschuk N, Wuethrich PY, Dundee P, Nair R, Furrer MA. A Systematic Review of Intra- and Postoperative Complication Reporting and Grading in Urological Surgery: Understanding the Pitfalls and a Path Forward. Eur Urol Oncol 2023:S2588-9311(23)00003-2. [PMID: 36697322 DOI: 10.1016/j.euo.2023.01.002] [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: 03/18/2022] [Revised: 11/30/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
CONTEXT Surgical outcomes and patient morbidity are often surrogate markers of health care quality and efficiency. These parameters can only be used with confidence if the reporting and grading of intra- and postoperative complications are reliable and reproducible. Without uniformity and regulation, the risk of under-reporting, and thus significant underestimation of the burden of intra- and postoperative morbidity, is high and should be of great concern to the international surgical community. OBJECTIVE To assess the quality and utility of currently available reporting and classification systems for intra- and postoperative complications, recognise their advantages and pitfalls, discuss the overall implications of these systems for urological surgery, and identify potential solutions for future reporting and classification systems. EVIDENCE ACQUISITION A comprehensive search was performed using multiple reputable databases and trial registries up to October 25, 2022. Only studies that adhered to predefined inclusion criteria were included. Study selection and data extraction were independently performed by two review authors. The review was performed according to strict methodological guidelines in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. EVIDENCE SYNTHESIS A total of 13 papers highlighting 13 various complication systems were critically assessed in this review. All studies proposed an intra- or postoperative complication reporting or grading system that was surgically related. At present, there is no single instrument in clinical practice to account for all relevant complication data. Six of the 13 studies were clinically validated (46%) and only three studies were urology-focused (23%). Meta-analysis was not possible. CONCLUSIONS Current individual complication tools are flawed, so there is a need for a novel, all-inclusive, specialty-specific reporting and classification system for intra- and postoperative complications. If successfully validated and integrated worldwide, such an instrument would have the potential to play a significant role in reshaping efficiency in health care systems and improving surgical and patient quality of care. PATIENT SUMMARY Current tools for reporting and classifying complications during and after surgery underestimate how burdensome such complications can be for patients. We summarise the reporting and classification tools currently available, discuss their advantages and drawbacks, and propose potential solutions for future systems. Our review can help in better understanding the changes required for future tools and how to improve overall surgical outcomes for patients.
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Affiliation(s)
- Christopher Soliman
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia.
| | - Niranjan J Sathianathen
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Benjamin C Thomas
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Nathan Lawrentschuk
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philip Dundee
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Rajesh Nair
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Marc A Furrer
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Urology, University of Bern, Bern, Switzerland; Department of Urology, Solothurner Spitäler AG, Olten and Solothurn, Switzerland
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Cacciamani GE, Eppler M, Sayegh AS, Sholklapper T, Mohideen M, Miranda G, Goldenberg M, Sotelo RJ, Desai MM, Gill IS. Recommendations for Intraoperative Adverse Events Data Collection in Clinical Studies and Study Protocols. An ICARUS Global Surgical Collaboration Study. Int J Surg Protoc 2023; 27:23-83. [PMID: 36818424 PMCID: PMC9912855 DOI: 10.29337/ijsp.183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction Intraoperative adverse events (iAEs) occur and have the potential to impact the postoperative course. However, iAEs are underreported and are not routinely collected in the contemporary surgical literature. There is no widely utilized system for the collection of essential aspects of iAEs, and there is no established database for the standardization and dissemination of this data that likely have implications for outcomes and patient safety. The Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration initiated a global effort to address these shortcomings, and the establishment of an adverse event data collection system is an essential step. In this study, we present the core-set variables for collecting iAEs that were based on the globally validated ICARUS criteria for surgical/interventional and anesthesiologic intraoperative adverse event collection and reporting. Material and Methods This article includes three tools to capture the essential aspects of iAEs. The core-set variables were developed from the globally validated ICARUS criteria for reporting iAEs (item 1). Next, the summary table was developed to guide researchers in summarizing the accumulated iAE data in item 1 (item 2). Finally, this article includes examples of the method and results sections to include in a manuscript reporting iAE data (item 3). Then, 5 scenarios demonstrating best practices for completing items 1-3 were presented both in prose and in a video produced by the ICARUS collaboration. Dissemination This article provides the surgical community with the tools for collecting essential iAE data. The ICARUS collaboration has already published the 13 criteria for reporting surgical adverse events, but this article is unique and essential as it actually provides the tools for iAE collection. The study team plans to collect feedback for future directions of adverse event collection and reporting. Highlights This article represents a novel, fully-encompassing system for the data collection of intraoperative adverse events.The presented core-set variables for reporting intraoperative adverse events are not based solely on our opinion, but rather are synthesized from the globally validated ICARUS criteria for reporting intraoperative adverse events.Together, the included text, figures, and ICARUS collaboration-produced video should equip any surgeon, anesthesiologist, or nurse with the tools to properly collect intraoperative adverse event data.Future directions include translation of this article to allow for the widest possible adoption of this important collection system.
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Affiliation(s)
- Giovanni E. Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Michael Eppler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Aref S. Sayegh
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Muneeb Mohideen
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Gus Miranda
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Mitch Goldenberg
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Rene J. Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Mihir M. Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Inderbir S. Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
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Cacciamani GE, Sholklapper T, Dell'Oglio P, Rocco B, Annino F, Antonelli A, Amenta M, Borghesi M, Bove P, Bozzini G, Cafarelli A, Celia A, Leonardo C, Ceruti C, Cindolo L, Crivellaro S, Dalpiaz O, Falabella R, Falsaperla M, Galfano A, Gallo F, Greco F, Minervini A, Parma P, Chiara Sighinolfi M, Pastore AL, Pini G, Porreca A, Pucci L, Sciorio C, Schiavina R, Umari P, Varca V, Veneziano D, Verze P, Volpe A, Zaramella S, Lebastchi A, Abreu A, Mitropoulos D, Shekhar Biyani C, Sotelo R, Desai M, Artibani W, Gill I. The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course. Eur Urol Focus 2022; 8:1847-1858. [PMID: 35177353 DOI: 10.1016/j.euf.2022.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. OBJECTIVE To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. DESIGN, SETTING, AND PARTICIPANTS The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS AND LIMITATIONS The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. CONCLUSIONS The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. PATIENT SUMMARY We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bernardo Rocco
- Urological Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | | | - Michele Amenta
- Department of Urology, Azienda ULSS n.4 Veneto Orientale, Portogruaro, Italy
| | | | | | | | | | - Antonio Celia
- Urology Unit, Ospedale San Bassiano, Bassano del Grappa, Italy
| | | | - Carlo Ceruti
- Urology Unit, AOU Citta della Salute e della Scienza, Turin, Italy
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, Mantova, Italy
| | | | | | | | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Luigi Pucci
- Urology Unit, Azienda Ospedaliera A. Cardarelli, Naples, Italy
| | | | | | - Paolo Umari
- Urology Unit, Ospedale Maggiore della Carita, Novara, Italy
| | - Virginia Varca
- Urology Unit, ASAT Rhodense Ospedale Guido Salvini di Garbagnate, Garbagnate, Italy
| | | | - Paolo Verze
- Urology Unit, AOU San Giovanni di Rio e Ruggi d'Aragona, Salerno, Italy
| | | | | | - Amir Lebastchi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dionysios Mitropoulos
- Department of Urology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chandra Shekhar Biyani
- Department of Urology, St. James' Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Inderbir Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
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Protocol for CAMUS Delphi Study: A Consensus on Comprehensive Reporting and Grading of Complications After Urological Surgery. Eur Urol Focus 2022; 8:1493-1511. [PMID: 35221259 DOI: 10.1016/j.euf.2022.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reproducible assessment of postoperative complications is essential for reliable evaluation of quality of care to enable comparison between healthcare centres and ensure transparent patient counselling. Currently, significant discrepancies exist in complication reporting and grading due to heterogeneous definitions and methodologies. OBJECTIVE To develop a standardised and reproducible assessment of perioperative complications and overall associated morbidity, to allow for the construction of a uniform language for complication reporting and grading. DESIGN, SETTING, AND PARTICIPANTS The 12-part REDCap-based Delphi survey was developed in conjunction with methodologist review and experienced urologist opinion. International urologists, anaesthetists, and intensive care unit specialists will be included. A minimum sample size of 750 participants (500 urologists and 250 critical care specialities) is targeted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The survey assesses participant demographics, opinion on complication reporting and the proposed Complications After Major & Minor Urological Surgery (CAMUS) reporting recommendations, grading of intervention events using the existing Clavien-Dindo classification and the proposed CAMUS classification, and rating of various clinical scenarios. Consensus will be defined as ≥75% majority agreement. If consensus is not reached, then subsequent Delphi rounds will be performed under steering committee guidance. RESULTS AND LIMITATIONS Twenty-one participants completed the draft survey. The median survey completion time was 128 min (interquartile range 88-135). The survey revealed that 90% of participants believe that the current complication classification systems are useful but inaccurate, while 100% of participants believe that there is a universal demand for reporting consensus. Several amendments were made following feedback. Limitations include complexity of the proposed supplemental grades and time to completion of the survey. CONCLUSIONS To ensure comprehensive and comparable complication reporting and grading across centres worldwide, a conclusive uniform language for complication reporting must be created. We intend to address shortcomings of the current complication reporting and classification systems with a new CAMUS classification system developed through multidisciplinary expert consensus obtained through a Delphi survey. Ultimately, standardisation of urological complication reporting and grading may improve patient counselling and quality of care. PATIENT SUMMARY The reporting and grading of operative complications that occur during or after an operation and associated costs provide a means to stratify quality of patient care. Current complication reporting and classification systems are not standardised and somewhat inaccurate, and thus significantly underestimate patient morbidity and surgical risk. This Delphi survey will provide the basis for the creation of a uniform complication reporting and grading system. Our new system may allow improved reporting and grading between centres, and ultimately improve patient counselling and care.
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15
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Sayegh AS, Eppler M, Ballon J, Hemal S, Goldenberg M, Sotelo R, Cacciamani GE. Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: “The Long Road from Assessment to Collection, Grading and Reporting”. J Clin Med 2022; 11:jcm11175115. [PMID: 36079044 PMCID: PMC9457420 DOI: 10.3390/jcm11175115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
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If You Know Them, You Avoid Them: The Imperative Need to Improve the Narrative Regarding Perioperative Adverse Events. J Clin Med 2022; 11:jcm11174978. [PMID: 36078908 PMCID: PMC9457276 DOI: 10.3390/jcm11174978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/21/2022] Open
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Tappero S, Dell'Oglio P, Longoni M, Buratto C, Palagonia E, Scilipoti P, Vecchio E, Martiriggiano M, Secco S, Olivero A, Barbieri M, Napoli G, Strada E, Petralia G, Di Trapani D, Bocciardi AM, Galfano A. Challenging cases in high-risk prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy. World J Urol 2022; 40:1993-1999. [PMID: 35771257 DOI: 10.1007/s00345-022-04073-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). METHODS 320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien-Dindo (CD) grade ≥ 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad. RESULTS Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14-300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD ≥ 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03). CONCLUSION HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. .,Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy. .,Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattia Longoni
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo Buratto
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Palagonia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Division of Urology, School of Medicine, Department of Clinical, Special and Dental Sciences, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
| | - Pietro Scilipoti
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Vecchio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy.,Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Marco Martiriggiano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy.,Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Barbieri
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giancarlo Napoli
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Strada
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Petralia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Di Trapani
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Reporting and grading of complications for intracorporeal robot-assisted radical cystectomy: an in-depth short-term morbidity assessment using the novel Comprehensive Complication Index ®. World J Urol 2022; 40:1679-1688. [PMID: 35670880 DOI: 10.1007/s00345-022-04051-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess suitability of Comprehensive Complication Index (CCI®) vs. Clavien-Dindo classification (CDC) to capture 30-day morbidity after robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS A total of 128 patients with bladder cancer (BCa) undergoing intracorporeal RARC with pelvic lymph node dissection between 2015 and 2021 were included in a retrospective bi-institutional study, which adhered to standardized reporting criteria. Thirty-day complications were captured according to a procedure-specific catalog. Each complication was graded by the CDC and the CCI®. Multivariable linear regression (MVA) was used to identify predictors of higher morbidity. RESULTS 381 complications were identified in 118 patients (92%). 55 (43%), 43 (34%), and 20 (16%) suffered from CDC grade I-II, IIIa, and ≥ IIIb complications, respectively. 16 (13%), 27 (21%), and 2 patients (1.6%) were reoperated, readmitted, and died within 30 days, respectively. 31 patients (24%) were upgraded to most severe complication (CCI® ≥ 33.7) when calculating morbidity burden compared to corresponding CDC grade accounting only for the highest complication. In MVA, only age was a positive estimate (0.44; 95% CI = 0.03-0.86; p = 0.04) for increased cumulative morbidity. CONCLUSION The CCI® estimates of 30-day morbidity after RARC were substantially higher compared to CDC alone. These measurements are a prerequisite to tailor patient counseling regarding surgical approach, urinary diversion, and comparability of results between institutions.
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Wijburg CJ, Hannink G, Michels CT, Weijerman PC, Issa R, Tay A, Decaestecker K, Wiklund P, Hosseini A, Sridhar A, Kelly J, d'Hondt F, Mottrie A, Klaver S, Edeling S, Dell'Oglio P, Montorsi F, Rovers MM, Witjes JA. Learning Curve Analysis for Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section Scientific Working Group. EUR UROL SUPPL 2022; 39:55-61. [PMID: 35528784 PMCID: PMC9068730 DOI: 10.1016/j.euros.2022.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure. Objective To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade ≥3), 90-d overall complications (OC90, Clavien-Dindo grades 1–5), operating time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). Design, setting, and participants This was a retrospective analysis of all consecutive iRARC cases from nine European high-volume hospitals with ≥100 cases. All patients had bladder cancer for which iRARC was performed, with an ileal conduit or neobladder as the urinary diversion. Outcome measurements and statistical analysis Outcome parameters used as a proxy for LC length were the number of consecutive cases needed to reach a plateau level in two-piece mixed-effects models for MC90, OC90, OT, EBL, and LOS. Results and limitations A total of 2186 patients undergoing iRARC between 2003 and 2018were included. The plateau levels for MC90 and OC90 were reached after 137 cases (95% confidence interval [CI] 80–193) and 97 cases (95% CI 41–154), respectively. The mean MC90 rate at the plateau was 14% (95% CI 7–21%). The plateau level was reached after 75 cases (95% CI 65–86) for OT, 88 cases (95% CI 70–106) for EBL, and 198 cases (95% CI 130–266) for LOS. A major limitation of the study is the difference in the balance of urinary diversion types between centres. Conclusions This multicentre retrospective analysis for the iRARC LC among nine European centres showed that 137 consecutive cases were needed to reach a stable MC90 rate. Patient summary We carried out a multicentre analysis of the surgical learning curve for robot-assisted removal of the bladder and bladder reconstruction in patients with bladder cancer. We found that 137 consecutive cases were needed to reach a stable rate of serious complications.
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20
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Arora A, Zugail AS, Pugliesi F, Cathelineau X, Macek P, Barbé Y, Karnes RJ, Ahmed M, Di Trapani E, Soria F, Alvarez-Maestro M, Montorsi F, Briganti A, Necchi A, Pradere B, D'Andrea D, Krajewski W, Roumiguié M, Bajeot AS, Hurle R, Contieri R, Carando R, Teoh JYC, Roupret M, Benamran D, Ploussard G, Mir MC, Sanchez-Salas R, Moschini M. Neoadjuvant chemotherapy does not increase peri-operative morbidity following radical cystectomy. World J Urol 2022; 40:1697-1705. [PMID: 35488914 DOI: 10.1007/s00345-022-04012-4] [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: 02/04/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether use of neoadjuvant chemotherapy (NAC) is associated with a higher risk of post-operative complications following radical cystectomy (RC) for bladder cancer (BCa). MATERIALS AND METHODS We retrospectively reviewed records of patients undergoing RC for non-metastatic urothelial BCa at 13 tertiary care centres from 2007-2019. Patients who received NAC ('NAC + RC' group) were compared with those who underwent upfront RC ('RC alone' group) for intra-operative variables, incidence of post-operative complications as per the Clavien-Dindo classification (CDC) and rates of re-admission and re-intervention. Multivariable logistic regression analysis was performed to determine predictors of CDC overall and CDC major (grade III-V) complications. We also analysed the trend of NAC utilization over the study period. RESULTS Of the 3113 patients included, 968 (31.1%) received NAC while the remaining 2145 (68.9%) underwent upfront RC for BCa. There was no significant difference between the NAC + RC and RC alone groups with regards to 30-day CDC overall (53.2% vs 54.6%, p = 0.4) and CDC major (15.5% vs 16.5%, p = 0.6) complications. The two groups were comparable for the rate of surgical re-intervention (14.6% in each group) and re-hospitalization (19.6% in NAC + RC vs 17.9% in RC alone, p = 0.2%) at 90 days. On multivariable regression analysis, NAC use was not found to be a significant predictor of 90-day CDC overall (OR 1.02, CI 0.87-1.19, p = 0.7) and CDC major (OR 1.05, CI 0.87-1.26, p = 0.6) complications. We also observed that the rate of NAC utilization increased significantly (p < 0.001) from 11.1% in 2007 to 41.2% in 2019, reaching a maximum of 48.3% in 2018. CONCLUSION This large multicentre analysis with a substantial rate of NAC utilization showed that NAC use does not lead to an increased risk of post-operative complications following RC for BCa. This calls for increasing NAC use to allow patients to avail of its proven oncologic benefit.
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Affiliation(s)
- Amandeep Arora
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. .,Department of Uro-Oncology, Tata Memorial Hospital, HBNI, Dr. Earnest Borges Road, Parel, Mumbai, 400012, India.
| | - Ahmed S Zugail
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.,Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Felipe Pugliesi
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.,Division of Urology, Men's Health Centre, Hospital Brigadeiro, São Paulo, SP, Brazil
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Yann Barbé
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | | | | | - Ettore Di Trapani
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Molinette Hospital, Turin, Italy
| | - Mario Alvarez-Maestro
- Department of Urology, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wrocław, Poland
| | - Mathieu Roumiguié
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Contieri
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Carando
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H.Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Morgan Roupret
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France
| | - Daniel Benamran
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France.,Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | | | - M Carmen Mir
- Department of Urology, Foundation Instituto Valenciano Oncologia, Valencia, Spain
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.,Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
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21
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Dell'Oglio P, Tappero S, Longoni M, Buratto C, Scilipoti P, Secco S, Olivero A, Barbieri M, Palagonia E, Napoli G, Strada E, Petralia G, Di Trapani D, Vanzulli A, Bocciardi AM, Galfano A. Retzius-sparing Robot-assisted Radical Prostatectomy in High-risk Prostate Cancer Patients: Results from a Large Single-institution Series. EUR UROL SUPPL 2022; 38:69-78. [PMID: 35265866 PMCID: PMC8898917 DOI: 10.1016/j.euros.2022.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background Retzius-sparing (RS) robot-assisted radical prostatectomy represents a valid surgical treatment option for prostate cancer (PCa) patients. However, the available evidence on the role of RS in high-risk (HR) PCa setting is sparse. Objective To describe our RS technique for HR-PCa patients and to evaluate intra-, peri-, and postoperative oncological and functional outcomes. Design, setting, and participants A total of 340 D’Amico HR-PCa patients underwent RS at a single high-volume centre between 2011 and 2020. Surgical procedure Surgical procedures were performed by five experienced robotic surgeons. Measurements Complications were collected according to the standardised methodology proposed by the European Association of Urology guidelines. Postoperative outcomes were evaluated in patients with complete follow-up data (n = 320). Biochemical recurrence (BCR) was defined as two consecutive prostate-specific antigen values of ≥0.2 ng/ml. Urinary continence (UC) recovery was defined as the use of zero or one safety pad. Kaplan-Meier and multivariable logistic and Cox regression models were performed. Results and limitations Fourteen patients (4%) experienced intraoperative complications and 52 90-d complications occurred in 44 patients (14%), of whom 24 had Clavien-Dindo 3a/b. Final pathology reported 49% International Society of Urological Pathology (ISUP) grade 4–5, 55% ≥pT3a, and 28.8% positive surgical margins (PSMs; 9.4% focal and 19.4% extended PSMs). The median follow-up was 47 mo. Overall, 35.3% and 1.3% harboured BCR and died from PCa. At 4 yr of follow-up, BCR-free survival and additional treatment-free survival were 63.6% and 56.6%, respectively. ISUP 4–5 at biopsy (odds ratio [OR]: 2.6), prostate volume (OR: 1.03), partial or full nerve sparing (OR: 1.9), and full bladder neck preservation (OR: 2.2) were independent predictors of PSMs. Pathological ISUP 4–5 (hazard ratio [HR]: 1.5) and PSMs (HR: 2.3) were independent predictors of BCR. Pathological ISUP 4–5 (HR: 1.5), PSMs (HR: 2.4), pT ≥3b (HR: 1.8), and pN ≥1 (HR: 1.8) were independent predictors of additional treatment. Immediate UC recovery was recorded in 53% patients. The 1- and 2-yr UC recovery and erectile function recovery were, respectively, 84% and 85%, and 43% and 50%. Conclusions RS in HR-PCa patients allows optimal intra-, peri-, and postoperative outcomes. The RS approach should be considered a valid surgical treatment option for HR-PCa patients in expert hands. Patient summary Relying on the largest cohort of high-risk prostate cancer patients treated with Retzius sparing (RS), we observed that the RS approach is safe and allows optimal cancer control, without significantly compromising functional outcomes.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Corresponding author. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. Tel. +39 02 6444 4617; Fax: +39 02 6444 7896.
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Mattia Longoni
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo Buratto
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pietro Scilipoti
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Barbieri
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Palagonia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giancarlo Napoli
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Strada
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Petralia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Di Trapani
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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22
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Wever L, de Vries HM, Dell'Oglio P, van der Poel HG, Donswijk ML, Sikorska K, van Leeuwen FWB, Horenblas S, Brouwer OR. Incidence and risk factor analysis of complications after sentinel node biopsy for penile cancer. BJU Int 2022; 130:486-495. [PMID: 35257463 DOI: 10.1111/bju.15725] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical staging is recommended in intermediate to high risk clinically node negative (cN0) penile cancer (PeCa). Because (modified) inguinal lymph node dissection (ILND) is associated with high morbidity, dynamic sentinel node biopsy (DSNB) was introduced with the aim to reduce morbidity while maintaining diagnostic accuracy. OBJECTIVE To determine the incidence and types of complications after DSNB and identify risk factors for the occurrence of postoperative complications. PATIENTS AND METHODS We evaluated 644 PeCa patients (1284 DSNB procedures) with at least one cN0 groin who underwent DSNB between 2011 and 2020 at a single high-volume centre. 30-day and 30-90-day postoperative complications were collected according to the modified Clavien Dindo classification and the standardized methodology proposed by the European Association of Urology panel. Univariable and multivariable generalized linear mixed models were used to identify risk factors for the occurrence of complications per groin. RESULTS A 30-day postoperative complication occurred in 14% of groins (n=186), of which 94% were mild to moderate. Wound infection and lymphocele formation were most common. 30-90-day postoperative complications occurred in 3.4% of the groins, all of which were mild or moderate (grade 1-2). The number of removed LNs per groin was the main independent predictor for any 30-day complications and grade≥2 complications (OR 1.40; p<0.001). An increase in the probability of postoperative complications with the number of LNs removed was observed after accounting for all confounders. CONCLUSIONS Despite being less morbid than (modified) ILND, DSNB is still associated with a considerable risk of mild to moderate postoperative complications. This risk increases with an increasing number of LNs removed. Further procedural refinement aimed at removing the true sentinel node(s) only, may help further reduce the morbidity of surgical staging in PeCa.
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Affiliation(s)
- Lieke Wever
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Hielke M de Vries
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Paolo Dell'Oglio
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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23
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Soliman C, Sathianathen NJ, Giannarini G, Wuethrich PY, Pan HYC, Thomas BC, Dundee P, Cumberbatch MG, Nair R, Lawrentschuk N, Furrer MA. There is a Need for a Universal Language in the Reporting and Grading of Complication and Intervention Events to Ensure Comparability and Improvement of Surgical Care. Eur Urol 2022; 81:440-445. [PMID: 35086720 DOI: 10.1016/j.eururo.2021.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/22/2021] [Indexed: 01/16/2023]
Abstract
To enhance the clarity and quality of complication reporting and grading for clinicians and patients, the CAMUS-Collaboration aims to develop the following: (1) a data dictionary; (2) parameters required for reporting; (3) risk-based reporting; (4) nursing and patient opinions; and (5) prospective reporting and grading of short- and long-term complications.
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Affiliation(s)
- Christopher Soliman
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Epworth Healthcare, Melbourne, Australia
| | - Niranjan J Sathianathen
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Epworth Healthcare, Melbourne, Australia
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Centre, Udine, Italy
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Henry Y C Pan
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Benjamin C Thomas
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Epworth Healthcare, Melbourne, Australia; The Australian Medical Robotics Academy, Melbourne, Australia
| | - Philip Dundee
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Epworth Healthcare, Melbourne, Australia; The Australian Medical Robotics Academy, Melbourne, Australia
| | | | - Rajesh Nair
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nathan Lawrentschuk
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Epworth Healthcare, Melbourne, Australia
| | - Marc A Furrer
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Epworth Healthcare, Melbourne, Australia; The Australian Medical Robotics Academy, Melbourne, Australia; Department of Urology, University of Bern, Bern, Switzerland.
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24
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Sathianathen NJ, Lawrentschuk N, Thalmann GN, Furrer MA. Re: Impact of the Implementation of the EAU Guidelines Recommendation on Reporting and Grading of Complications in Patients Undergoing Robot-assisted Radical Cystectomy: A Systematic Review. Eur Urol 2021; 81:214-215. [PMID: 34920896 DOI: 10.1016/j.eururo.2021.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
| | | | - Marc A Furrer
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia; Department of Urology, University of Bern, Bern, Switzerland; The Australian Medical Robotics Academy, Melbourne, Australia.
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25
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Grauer R, Wiklund NP. Update on robotic cystectomy. Curr Opin Urol 2021; 31:537-541. [PMID: 34506337 DOI: 10.1097/mou.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article aims to discuss recently published (2019-2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics. RECENT FINDINGS RARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming. SUMMARY ORC is the current 'gold standard' management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed-informing further adoption of the technique.
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Affiliation(s)
- Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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26
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The Unsolved Issue of Reporting of Late Complications in Urology. Eur Urol 2021; 80:527-528. [PMID: 34362581 DOI: 10.1016/j.eururo.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Lack of uniformity in the reporting of late complications hampers the quality of data available on surgical outcomes. Adoption of standardized criteria and a taxonomy for reporting of late complications is urgently needed.
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