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Pan DL, Zhang LF, Li XJ, Zhang KP, Gao PF, Yang B, Li NC. Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer. BMC Cancer 2024; 24:159. [PMID: 38297199 PMCID: PMC10829394 DOI: 10.1186/s12885-024-11816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.
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Affiliation(s)
- Dong-Liang Pan
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Lu-Fang Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China.
| | - Xiao-Jian Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ke-Ping Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Peng-Fei Gao
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Bing Yang
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ning-Chen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
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2
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Mally D, Pfister D, Heidenreich A, Albers P, Niegisch G. [Does robotic radical cystectomy affect oncological outcomes in bladder cancer patients?]. Aktuelle Urol 2022; 53:153-158. [PMID: 35345013 DOI: 10.1055/a-1745-8521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.
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Affiliation(s)
- David Mally
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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3
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Grunewald CM, Feldmeier V, Supprian T, Albers P, Giessing M, Niegisch G. Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study. Ther Adv Urol 2022; 14:17562872221087660. [PMID: 35356753 PMCID: PMC8958686 DOI: 10.1177/17562872221087660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Background: Impaired cognitive function of bladder cancer patients plays a role in coping with the kind of urinary diversion and may impact perioperative morbidity. In this study we therefore aimed to assess the prevalence of mild cognitive impairment in patients undergoing radical cystectomy. Secondary objectives included correlation of common cognition tests, assessment of the admitting physician, and perioperative complication rates. Methods: Patients undergoing radical cystectomy for bladder cancer were prospectively screened by neuropsychological tests including cognition tests [DemTect (Dementia Detection test), MMSE (Mini-Mental State Examination), clock drawing test] prior to surgery. Besides, clinical characteristics and perioperative outcomes were documented. Frequency of mild cognitive impairment as assessed by DemTect was correlated with the results of MMSE and clock drawing test, the occurrence of anxiety and depression, the assessment of the admitting physician, and perioperative complication rates as calculated by Spearman rank correlation coefficient. Comparative analysis (parametric and nonparametric) of patient characteristics (nonpathological versus pathological DemTect suggestive of mild cognitive impairment) was performed. Results: A total of 51 patients (80% male, median age 69 years) were analyzed. DemTect was suspicious of mild cognitive impairment in 27% (14/51) of patients, whereas MMSE and clock drawing test showed pathological results only in 10/51 and 6/51 patients, respectively. We found no correlation between mild cognitive impairment and anxiety/depression status. In all, 5/20 patients (25%) with suspicious DemTect results were considered suitable for a continent diversion neobladder by the admitting physician. Suspicious DemTect results were predictive for higher perioperative complication rates (29% versus 5%). Study limitations include small sample size and missing long-term follow-up. Conclusions: Mild cognitive impairment was observed in more than a quarter of radical cystectomy patients prior to surgery. Preoperative assessment should be supplemented by neuropsychological testing such as the DemTect as mild cognitive impairment is often underestimated and associated with significantly higher perioperative complication rates.
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Affiliation(s)
- Camilla M. Grunewald
- Department of Urology, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Vera Feldmeier
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tillmann Supprian
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Giessing
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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4
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Dong L, Qin Y, Ya L, Liang C, Tinghui H, Pinlin H, Jin Y, Youliang W, Shu C, Tao W. Bayesian network analysis of open, laparoscopic, and robot-assisted radical cystectomy for bladder cancer. Medicine (Baltimore) 2020; 99:e23645. [PMID: 33350743 PMCID: PMC7769378 DOI: 10.1097/md.0000000000023645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We have performed the direct and network meta-analysis to evaluate the safety and efficacy of robot-assisted (RARC) versus laparoscopic (LRC) versus open radical cystectomy (ORC) for bladder cancer (BCa). METHODS A systematic search of PubMed, Cochrane Library, and Embase was performed up until Dec 20, 2019. Outcome indexes include oncologic outcomes (the recurrence rate, mortality), pathologic outcomes (lymph node yield (LNY), positive lymph node (PLN), positive surgical margins (PSM)), perioperative outcomes (operating time (OP), estimated blood loss (EBL), blood transfusion rate, the length of hospital stay (LOS) and the time to regular diet) and postoperative 90-day complications. RESULTS We have analyzed 6 RCTs, 23 prospective studies, and 25 retrospective studies (54 articles: 6382 patients). On one hand, the direct meta-analysis shows RARC is better than LRC or ORC. On the other hand, the clinical effects of the recurrence rate, Morbidity, PSM, LNY, PLN, and postoperative 90-day complications of RARC, LRC and ORC are all no statistical significance by network meta-analysis. Moreover, the probability rank shows that the comprehensive rank of RARC is better than LRC or ORC. The clinical effects of OP, EBL, LOS, blood transfusion rate and the time to regular diet are all statistical significance by network meta-analysis. There are ORC > LRC > RARC in the EBL ranking. Patients with RARC exhibited a decrease of LOS compared to those with LRC or ORC. Patients with RARC exhibited a decrease in blood transfusion rate and the time to regular diet compared to those with ORC. Patients with ORC exhibited an increase of OP compared to those with RARC or LRC. The heterogeneity tests of most studies are < 50%. Most studies have no publication bias and the quality of the selected studies is good. CONCLUSION The direct meta-analysis and network meta-analysis suggest that RARC is better than LRC or ORC according to comprehensive analysis. However, we need a large sample size and more high-quality studies to verify and improve in the further.
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Affiliation(s)
- Lin Dong
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Yu Qin
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu
| | - Lu Ya
- Department of Respiratory, Affiliated Hospital of Chengdu Medical College
| | - Cao Liang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Hu Tinghui
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - He Pinlin
- Department of Urology, Affiliated Hospital of Chengdu University
| | - Yang Jin
- Department of Urology, Affiliated Hospital of Chengdu University
| | - Wang Youliang
- Department of Laboratory, Pengzhou People's Hospital, Chengdu, Sichuan, China
| | - Cui Shu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Wu Tao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
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Clement KD, Pearce E, Gabr AH, Rai BP, Al-Ansari A, Aboumarzouk OM. Perioperative outcomes and safety of robotic vs open cystectomy: a systematic review and meta-analysis of 12,640 cases. World J Urol 2020; 39:1733-1746. [PMID: 32734460 DOI: 10.1007/s00345-020-03385-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Robotic radical cystectomy (RRC) has become a commonly utilised alternative to open radical cystectomy (ORC). We performed a systematic review and meta-analysis of RRC vs ORC focusing on perioperative outcomes and safety. METHODS Medline, EMBASE and CENTRAL were searched from January 2000 to April 2020 following the Preferred Reporting Items for Systematic Review and Meta-analysis Statement for study selection. RESULTS In total, 47 studies (5 randomised controlled trials, 42 non-randomised comparative studies) comprising 12,640 patients (6572 ORC, 6068 RRC) were included. There was no difference in baseline demographics between the groups apart from males were more likely to undergo ORC (OR 0.77, 95% CI 0.69-0.85). Those with muscle-invasive disease were more likely to undergo RRC (OR 1.21, 95% CI 1.09-1.34), and those with high-risk non-muscle-invasive bladder cancer were more likely to undergo ORC (OR 0.80, 95% CI 0.72-0.89). RRC had a significantly longer operating time, less blood loss and lower transfusion rate. There was no difference in lymph node yield, rate of positive surgical margins, or Clavien-Dindo Grade I-II complications between the two groups. However, the RRC group were less likely to experience Clavien-Dindo Grade III-IV (OR 1.56, 95% CI 1.30-1.89) and overall complications (OR 1.45, 95% CI 1.26-1.68) than the ORC group. The mortality rate was higher in ORC although this did not reach statistical significance (OR 1.52, 95% CI 0.99-2.35). CONCLUSION RRC has significantly lower blood loss, transfusion rate and is associated with fewer high grade and overall complications compared to ORC.
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Affiliation(s)
- Keiran D Clement
- Department of Urology, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, UK.
| | - Emily Pearce
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, UK
| | - Ahmed H Gabr
- Department of Urology, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, UK
- Department of Urology, Minia University, Minia, Egypt
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abdulla Al-Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- University of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
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6
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Grunewald CM, Henn A, Galsky MD, Plimack ER, Harshman LC, Yu EY, Crabb SJ, Pal SK, Alva AS, Powles T, De Giorgi U, Agarwal N, Bamias A, Ladoire S, Necchi A, Vaishampayan UN, Sternberg CN, Bellmunt J, Baniel J, Niegisch G. Impact of timing of adjuvant chemotherapy following radical cystectomy for bladder cancer on patient survival. Urol Oncol 2020; 38:934.e1-934.e9. [PMID: 32660788 DOI: 10.1016/j.urolonc.2020.06.008] [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: 03/12/2020] [Revised: 05/12/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Trials of adjuvant chemotherapy following radical cystectomy generally require chemotherapy to start within 90 days postoperatively. However, it is unclear, whether the interval between surgery and start of adjuvant therapy (S-AC-interval) impacts the oncological outcome. METHODS Using the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC) data base, we identified patients who underwent radical cystectomy for muscle invasive bladder cancer and subsequent adjuvant chemotherapy. Univariate analysis of patient characteristics, surgical factors and tumor characteristics regarding their impact on S-AC-interval was performed using Kruskal-Wallis testing and Fisher's exact test. Analysis of progression-free (PFS) and overall survival (OS) (follow-up time beginning with the start date of adjuvant chemotherapy) was analyzed in relation to S-AC-interval (continuous and dichotomous with a cut-off at 90 days) using Kaplan-Meier method and COX regression analysis. RESULTS We identified 238 eligible patients (83.5% male, mean age: 63.4 years, 76.1% T3/T4, 66.4% pN+, 14.7% R+, 70.6% urothelial carcinoma, 71% cisplatin-based adjuvant chemotherapy). The majority of patients (n = 207, 87%) started chemotherapy within 90 days after surgery. Median S-AC-interval was 57 days (interquartile range 32.8). S-AC-interval did not have consistent association with any patient/tumor characteristics or surgery related factors (type of surgery, urinary diversion). Survival analysis using continuous S-AC-interval revealed a trend toward an impact of S-AC-interval on OS (hazard ratio 1.004, 95% confidence ratio 0.9997-1.0084, P = 0.071). With regards to PFS, that impact was shown to be statistically significant (hazard ratio 1.004, 95% confidence ratio 1.0003-1.0075, P = 0.032). In multivariate analysis, however, S-AC-interval was negated by tumor and patient related factors (pathological T-stage, N-stage, ECOG performance status). Accounting for eligibility criteria defined in some clinical trials, we extended our analysis dividing S-AC-interval in ≤90 and >90 days. Although we could confirm the trend toward better outcome in patients with a shorter S-AC interval in dichotomous analysis, neither differences in OS nor in PFS reached statistical significance (P = 0.438 and P = 0.056). CONCLUSIONS In a large multi-institutional experience, 87% of patients who received adjuvant chemotherapy received it within the guideline recommended window of 90 days. While it was not possible to determine whether this is the optimal cut-off, early start of adjuvant chemotherapy seems to be reasonable. Regarding prognosis, tumor-related pathological factors abrogated the importance of the S-AC-interval in our analysis.
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Affiliation(s)
- Camilla M Grunewald
- Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
| | | | - Matthew D Galsky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | | | - Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Evan Y Yu
- University of Washington, Seattle, WA
| | - Simon J Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, Royal Free NHS Trust, London, United Kingdom
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aristotelis Bamias
- Haematology-Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sylvain Ladoire
- Department of Medical Oncology, Center GF Leclerc, Dijon, France
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Cora N Sternberg
- Englander Institute of Precision Medicine, Weill Cornell Medicine, New York, NY
| | - Joaquim Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Guenter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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7
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Zhang S, Lin T, Zhang Q, Zhang S, Liu G, Ji C, Guo H. Comparison of perioperative outcomes in robot‐assisted radical cystectomy and laparoscopic radical cystectomy. Int J Med Robot 2020; 16:e2074. [PMID: 31922333 DOI: 10.1002/rcs.2074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Shiwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
| | - Tingsheng Lin
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
| | - Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
| | - Shengjie Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
| | - Guangxiang Liu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
| | - Changwei Ji
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of UrologyNanjing University Nanjing China
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8
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Tzelves L, Skolarikos A, Mourmouris P, Lazarou L, Kostakopoulos N, Manatakis DK, Kural AR. Does the Use of a Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open with Robotic Counterparts. J Endourol 2019; 33:971-984. [PMID: 31161777 DOI: 10.1089/end.2019.0226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Radical cystectomy (RC) is the mainstay of treatment for muscle-invasive bladder cancer. In 2003, the first robot-assisted radical cystectomy (RARC) was performed and since then many studies, mainly observational, were conducted to compare robotic and open methods. This study aims to assess perioperative outcomes between the two methods based on pooled data from existing literature. Methods: A literature search of articles in English and French languages was performed in three databases (Medline, Embase, and Cochrane) until 30th of June 2018, as well as in urology conference programs and reference lists of included studies. The study protocol was registered at PROSPERO (CRD42018103063). Terms such as "robotic," "open," and "radical cystectomy" and synonyms were used for the searching algorithm. The primary outcome was the number of minor and major postoperative complications (Clavien grading system). Risk of bias was assessed with the Cochrane tool and Newcastle-Ottawa scale. Comparison of continuous outcomes was performed with weighted mean differences, while for dichotomous outcomes, odds ratios (ORs) were used. Review Manager 5.3 was used. Results: Fifty-four studies (5 randomized trials and 49 observational) were eligible, including 29,697 patients (6500 in the RARC group and 23,197 in the open radical cystectomy group). Minor complications (grade 1-2) in pooled data of 29 studies were fewer in the RARC group (OR = 0.54, 95% confidence interval [CI]: 0.38-0.76, p < 0.001), a difference persisting after sensitivity analysis for 30 and 90 days. Major complications (grade 3-5) in 31 studies were fewer in the RARC group (OR = 0.78, 95% CI: 0.65-0.94, p = 0.009), but this difference disappeared in the 30-day subanalysis. RARC was associated with lower blood transfusion rates (p < 0.001), lower length of stay (p < 0.001), faster return to regular diet (p < 0.001), and lower postoperative mortality rates (p < 0.001), but longer operating time. Conclusions: RARC appears to be associated with fewer complications and favoring perioperative outcomes in comparison with the open method. Due to the observational nature of most studies, larger randomized trials are needed to confirm these findings.
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Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Mourmouris
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Lazarou
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kostakopoulos
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ali Riza Kural
- Department of Urology, School of Medicine, Acibadem Maslak Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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9
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Kimura S, Iwata T, Foerster B, Fossati N, Briganti A, Nasu Y, Egawa S, Abufaraj M, Shariat SF. Comparison of perioperative complications and health-related quality of life between robot-assisted and open radical cystectomy: A systematic review and meta-analysis. Int J Urol 2019; 26:760-774. [PMID: 31083783 PMCID: PMC6851708 DOI: 10.1111/iju.14005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/31/2019] [Indexed: 01/23/2023]
Abstract
To compare postoperative complications and health‐related quality of life of patients undergoing robot‐assisted radical cystectomy with those of patients undergoing open radical cystectomy. A systematic search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. A pooled meta‐analysis was carried out to assess the differences between robot‐assisted radical cystectomy and open radical cystectomy according to randomized and non‐randomized comparative studies, respectively. We identified six randomized comparative studies and 31 non‐randomized comparative studies. Most robot‐assisted radical cystectomy patients were treated with extracorporeal urinary diversion. Robot‐assisted radical cystectomy was associated with longer operative times, and lower blood loss and transfusion rates compared with open radical cystectomy in both randomized comparative studies and non‐randomized comparative studies. There was no significant difference between robot‐assisted radical cystectomy and open radical cystectomy in the rate of patients with any or major complications within 90 days both in randomized comparative studies and non‐randomized comparative studies. Non‐randomized comparative studies reported a lower rate of complications at 30 days, mortality at 90 days and length of stay for patients treated with robot‐assisted radical cystectomy, which were not confirmed in randomized comparative studies. Additionally, there were no differences in postoperative quality of life score assessment at 3 and 6 months between robot‐assisted radical cystectomy and open radical cystectomy. Robot‐assisted radical cystectomy is associated with less blood loss and lower transfusion rates. There is no difference in complications, length of stay, mortality, and quality of life between robot‐assisted radical cystectomy and open radical cystectomy. Data from non‐randomized comparative studies favor perioperative outcomes in robot‐assisted radical cystectomy patients, the failure to confirm in randomized comparative studies, likely due to bias in study design and reporting. Further randomized comparative studies comparing postoperative complications and quality of life between robot‐assisted radical cystectomy with intracorporeal urinary diversion and open radical cystectomy are required to assess potential differences between these two surgical approaches.
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Affiliation(s)
- Shoji Kimura
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takehiro Iwata
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Nicola Fossati
- Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, New York, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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10
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Tyritzis SI, Gaya JM, Wallestedt-Lantz A, Pini G, Everaerts W, de Naeyer G, Palou J, Kelly J, Wiklund NP. Current role of robotic bladder cancer surgery. MINERVA UROL NEFROL 2019; 71:301-308. [PMID: 31086134 DOI: 10.23736/s0393-2249.19.03435-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC. EVIDENCE ACQUISITION A non-systematic review on all relevant studies with the keywords "Radical cystectomy," "Open," "Robot-assisted," "Complications," "Recurrence," "Survival," "Neobladder," "Potency," "Continence" and "Intracorporeal" was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines. EVIDENCE SYNTHESIS RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique. CONCLUSIONS As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects.
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Affiliation(s)
- Stavros I Tyritzis
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden - .,Department of Urology, HYGEIA Hospital, Athens, Greece -
| | - Josep M Gaya
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Wallestedt-Lantz
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden
| | - Giovannalberto Pini
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Wouter Everaerts
- Department of Urology, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Joan Palou
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Nils P Wiklund
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm Sweden.,ICAHN School of Medicine, Mount Sinai Hospital, New York, NY, USA
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11
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Niegisch G. Does robotic radical cystectomy impede oncological outcome in bladder cancer patients? Transl Androl Urol 2019; 7:S744-S746. [PMID: 30687614 PMCID: PMC6323284 DOI: 10.21037/tau.2018.08.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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12
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Jaramillo Valencia J, González A, Acosta R. Tipo de derivación urinaria en el paciente llevado a cistectomía radical, participación del urólogo y tasa de filtración de la anastomosis intestinal. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objetivo Conocer la prevalencia de cistectomías radicales que se realizan en centros especializados en Colombia, definiendo tipo de derivación intestinal, participantes en su creación, segmento intestinal utilizado y tasa de filtración.
Materiales y métodos Se realizó una encuesta a instituciones de salud colombianas que realizan cistectomías radicales de manera rutinaria, se analizaron variables como número de procedimientos por año, segmento intestinal utilizado, tipo de especialidad participante en la anastomosis intestinal y la tasa de filtración de esta.
Resultados Quince instituciones colombianas respondieron la encuesta, el número de cistectomías realizadas por año fue: 5/15 (33,3%) más de 15 cirugías al año, 4/15(26,6%) entre 11 y 15 procedimientos al año, 3/15 (20%) entre 5 y 10 y otro 3/15 (20%) entre 1 y 5 cistectomías al año. El 93,3% de las instituciones realizan Bricker como derivación más común; solo una institución (6,7%) lleva a cabo ureterostomías cutáneas. Con respecto a los participantes en la creación de la anastomosis de las 14 instituciones, en 9 (64,2%) es realizada por cirujano general, en 4 (28,5%) la lleva a cabo un urólogo y en una (7,4%) la derivación es realizada por coloproctólogo. La gran mayoría de los centros tiene una incidencia baja de filtración intestinal.
Conclusiones En la gran mayoría de las instituciones colombianas el cirujano general y en menor medida el urólogo participan en la creación de la anastomosis intestinal como parte del protocolo de la institución. La filtración es una complicación poco frecuente pero con alta morbimortalidad. Se requiere de entrenamiento por parte del urólogo en formación para lograr mejores resultados.
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Affiliation(s)
| | - Andrés González
- Residente Urología III año, Universidad CES, Medellín, Colombia
| | - Rafael Acosta
- Urólogo, Jefe Postgrado Urología, Universidad CES, Medellín, Colombia
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13
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Abstract
Robot-assistance is being increasingly used for radical cystectomy (RC). Fifteen years of surgical evolution might be considered a short period for a radical procedure to be established as the treatment of choice, but robot assisted radical cystectomy (RARC) is showing promising results when compared with the current gold standard, open RC (ORC). In this review, we describe the current status of RARC and continue the discussion on the on-going RARC versus ORC debate.
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Affiliation(s)
- Stavros Ioannis Tyritzis
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
| | - Justin W Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
| | - Nils Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece
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14
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DiLizia EM, Sadeghi F. Surgical and pathological outcomes of robotic-assisted radical cystectomy for bladder cancer in the community setting. J Robot Surg 2017; 12:337-341. [DOI: 10.1007/s11701-017-0740-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
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15
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Lauridsen SV, Tønnesen H, Jensen BT, Neuner B, Thind P, Thomsen T. Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs. Syst Rev 2017; 6:150. [PMID: 28768530 PMCID: PMC5541663 DOI: 10.1186/s13643-017-0547-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/20/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radical cystectomy is associated with high rates of perioperative morbidity. Robotic-assisted radical cystectomy (RARC) is widely used today despite limited evidence for clinical superiority. The aim of this review was to evaluate the effect of RARC compared to open radical cystectomy (ORC) on complications and secondary on length of stay, time back to work and health-related quality of life (HRQoL). METHODS The databases PubMed, The Cochrane Library, Embase and CINAHL were searched. A systematic review according to the PRISMA guidelines and cumulative analysis was conducted. Randomized controlled trials (RCTs) that examined RARC compared to ORC were included in this review. We assessed the quality of evidence using the Cochrane Collaboration's 'Risk of bias' tool and Grading of Recommendations Assessment, Development and Evaluation approach. Data were extracted and analysed. RESULTS The search retrieved 273 articles. Four RCTs were included involving overall 239 patients. The quality of the evidence was of low to moderate quality. There was no significant difference between RARC and ORC in the number of patients developing complications within 30 or 90 days postoperatively or in overall grade 3-5 complications within 30 or 90 days postoperatively. Types of complications differed between the RARC and the ORC group. Likewise, length of stay and HRQoL at 3 and 6 months did not differ. CONCLUSION Our review presents evidence for RARC not being superior to ORC regarding complications, LOS and HRQoL. High-quality studies with consistent registration of complications and patient-related outcomes are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038232.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, 2112, Rigshospitalet, 2100, Copenhagen, Denmark.
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.,Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Sweden.,Health Science, University of Southern Denmark, Odense, Denmark
| | - Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital and Centre of Research in Rehabilitation, Aarhus University, Aarhus, Denmark
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Thind
- Department of Urology, Copenhagen University Hospital, 2112, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, University Hospital of Copenhagen, Health and Medical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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16
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Necchi A, Pond GR, Smaldone MC, Pal SK, Chan K, Wong YN, Viterbo R, Sonpavde G, Harshman LC, Crabb S, Alva A, Chowdhury S, De Giorgi U, Srinivas S, Agarwal N, Bamias A, Baniel J, Golshayan AR, Ladoire S, Sternberg CN, Cerbone L, Yu EY, Bellmunt J, Vaishampayan U, Niegisch G, Hussain S, Bowles DW, Morales-Barrera R, Milowsky MI, Theodore C, Berthold DR, Sridhar SS, Powles T, Rosenberg JE, Galsky MD. Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist's Perspective from a Multicentre Study. Eur Urol Focus 2017; 4:937-945. [PMID: 28753879 DOI: 10.1016/j.euf.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/07/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC). OBJECTIVE To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment. DESIGN, SETTING, AND PARTICIPANTS Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013. INTERVENTION RARC or ORC combined with perioperative chemotherapy for UBC. OUTCOME MEASURES AND STATISTICAL ANALYSIS Fisher's exact tests, χ2 tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors. RESULTS AND LIMITATIONS A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation. CONCLUSIONS In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint. PATIENT SUMMARY In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | | | | | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kevin Chan
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | - Guru Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL, USA
| | | | | | - Ajjai Alva
- University of Michigan, Ann Arbor, MI, USA
| | | | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy
| | - Sandy Srinivas
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA
| | | | | | | | | | - Daniel W Bowles
- Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Matthew I Milowsky
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA
| | | | | | - Srikala S Sridhar
- Princess Margaret Hospital, University Health Network, Toronto, Canada
| | - Thomas Powles
- Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK
| | | | - Matthew D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA
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17
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Son SK, Lee NR, Kang SH, Lee SH. Safety and Effectiveness of Robot-Assisted Versus Open Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 27:1109-1120. [PMID: 28350238 DOI: 10.1089/lap.2016.0437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC) in bladder cancer. METHODS A literature search for the systematic review was conducted using international databases as well as domestic databases up to April 2015. Outcomes of interest included baseline characteristics, complication rates, perioperative, and oncologic outcomes. RESULTS Twenty-four articles were finally selected for inclusion in the meta-analysis. Complication rates of RARC were similar to those of ORC, except for 90-day overall complication rate, wound dehiscence, abscess, pneumonia, respiratory failure, and sepsis, which was lower after RARC. RARC was also associated with a smaller amount of estimated blood loss, lower transfusion rate, shorter length of hospital stay, shorter time to flatus, and more lymph node yield, whereas ORC was associated with a shorter operation time and lower rate of stricture. Considering oncologic outcomes, there were no differences between RARC and ORC. CONCLUSIONS RARC seems to be associated with equivalent complication rates, a smaller amount of estimated blood loss, lower transfusion rate, shorter length of hospital stay, shorter time to flatus, and more lymph node yield. Randomized controlled trials with a large sample size and comparative studies with long-term follow-up data are warranted to assess our findings and the oncologic effectiveness of RARC.
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Affiliation(s)
- Soo Kyung Son
- 1 Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,2 Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University , Seoul, Korea
| | - Na Rae Lee
- 1 Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,2 Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University , Seoul, Korea
| | - Seok Ho Kang
- 3 Department of Urology, College of Medicine, Korea University , Seoul, Korea
| | - Seon Heui Lee
- 4 Department of Nursing Science, College of Nursing, Gachon University , Incheon, Korea
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18
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Krajewski W, Zdrojowy R, Tupikowski K, Małkiewicz B, Kołodziej A. How to lower postoperative complications after radical cystectomy - a review. Cent European J Urol 2016; 69:370-376. [PMID: 28127453 PMCID: PMC5260457 DOI: 10.5173/ceju.2016.880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/16/2016] [Accepted: 10/13/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Lowering morbidity and mortality after RC is subject of considerable interest. Lately, many evidence-based data on improvements in operative technique, anesthetic management, and patient care have been published. In this article, we present a review of literature on how to lower postoperative complications after RC. Material and methods The Medline, and Web of Science databases were searched without a time limit on February 2016 using the terms ‘cystectomy’ in conjunction with ‘radical’, ‘bladder cancer’, ‘complications’ or ‘management’. Boolean operators (NOT, AND, OR) were also used in succession to narrow and broaden the search. The search was limited to the English, Polish and Spanish literature. Results Many complications may be avoided by appropriate patient selection and meticulous introduction of care protocols. Conclusions RC as treatment free of complications, even in the hands of an experienced urologist, does not exist. A large number of complications are acceptable in the name of good long-term results. Optimum results are possible with proper surgical technique, good patients and urinary diversion selection and proper patient management in the pre-, peri, and postoperative period.
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Affiliation(s)
- Wojciech Krajewski
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Tupikowski
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
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19
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Danna BJ, Wood EL, Baack Kukreja JE, Shah JB. The Future of Enhanced Recovery for Radical Cystectomy: Current Evidence, Barriers to Adoption, and the Next Steps. Urology 2016; 96:62-68. [DOI: 10.1016/j.urology.2016.04.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/15/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
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20
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Surgical control and margin status after robotic and open cystectomy in high-risk cases: Caution or equivalence? World J Urol 2016; 35:657-663. [PMID: 27495912 DOI: 10.1007/s00345-016-1915-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/29/2016] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The benefits of robotic-assisted radical cystectomy (RARC) are unclear, especially in patients with high-risk disease (pT3/T4). We evaluated pathological and postoperative outcomes of RARC versus open radical cystectomy (ORC) in these patients. METHODS We identified bladder cancer patients treated with RARC or ORC from January 2010-August 2014. Clinicodemographic factors were examined for potential confounding. Our primary outcome of interest was positive soft-tissue surgical margins (STSMs). Secondary outcomes included post-operative complications and length of stay (LOS). We used logistic regression to define the association between clinical factors with outcomes of interest, focusing on patients with locally advanced disease. RESULTS We identified 472 patients treated with ORC (407, 86.2 %) or RARC (65, 13.8 %) of which 215 (45.6 %) were high-risk cases based on advanced pathologic stage (pT3/4). RARC patients were more commonly men (96.9 vs. 73.2 %, p < 0.01), had better performance status (ECOG 0, 78.5 vs. 59.7 %, p = 0.031), and received less neoadjuvant chemotherapy (21.5 vs. 39.3 %, p = 0.006). Total (52.3 vs. 59.7 %, p = 0.26) and high-grade complication rates (13.8 vs. 19.7 %, p = 0.27) were similar, but median LOS was shorter after RARC (6 vs. 7 days, p < 0.01). On multivariate analysis, prior pelvic radiation (OR: 4.78, 95 % CI: 2.16-10.57), and advanced tumor stage (OR: 3.06, 95 % CI: 1.56-6.03) were independently associated with positive STSMs in high-risk patients but robotic surgical approach was not (OR: 0.81, 95 % CI: 0.29-2.30; p = 0.69). CONCLUSION RARC had similar short-term postoperative outcomes compared to ORC and did not compromise oncological control in patients with extravesical disease.
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21
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Deboudt C, Perrouin-Verbe MA, Le Normand L, Perrouin-Verbe B, Buge F, Rigaud J. Comparison of the morbidity and mortality of cystectomy and ileal conduit urinary diversion for neurogenic lower urinary tract dysfunction according to the approach: Laparotomy, laparoscopy or robotic. Int J Urol 2016; 23:848-853. [DOI: 10.1111/iju.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Loic Le Normand
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation; University Hospital of Nantes; Nantes France
| | - François Buge
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Jérôme Rigaud
- Department of Urology; University Hospital of Nantes; Nantes France
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22
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Chalfin HJ, Liu JJ, Gandhi N, Feng Z, Johnson D, Netto GJ, Drake CG, Hahn NM, Schoenberg MP, Trock BJ, Scott AV, Frank SM, Bivalacqua TJ. Blood Transfusion is Associated with Increased Perioperative Morbidity and Adverse Oncologic Outcomes in Bladder Cancer Patients Receiving Neoadjuvant Chemotherapy and Radical Cystectomy. Ann Surg Oncol 2016; 23:2715-22. [DOI: 10.1245/s10434-016-5193-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Indexed: 01/07/2023]
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23
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Guancial EA, Roussel B, Bergsma DP, Bylund KC, Sahasrabudhe D, Messing E, Mohile SG, Fung C. Bladder cancer in the elderly patient: challenges and solutions. Clin Interv Aging 2015; 10:939-49. [PMID: 26089655 PMCID: PMC4467651 DOI: 10.2147/cia.s74322] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Bladder cancer (BC) is an age-associated malignancy with increased prevalence in the elderly population. Elderly patients are a vulnerable population at increased risk for treatment-related toxicity secondary to medical comorbidities and geriatric syndromes. As a result, this population has been historically undertreated and suffers worse disease-specific outcomes than younger patients with BC. Recognition of this disparity has led to efforts to individualize treatment decisions based on functional status rather than chronologic age in an effort to optimize the use of curative therapies for the fit elderly and modify treatments to reduce the risk of toxicity and disease-related morbidity in vulnerable or frail patients. The comprehensive geriatric assessment is a decision framework that helps to balance underlying health considerations and risks of therapy with aggressiveness of the cancer. Development of systemic therapies with increased efficacy against BC and reduced toxicity are eagerly awaited, as are techniques and interventions to reduce the morbidity from surgery and radiation for patients with BC.
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Affiliation(s)
- Elizabeth A Guancial
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Breton Roussel
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Derek P Bergsma
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Kevin C Bylund
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Deepak Sahasrabudhe
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Edward Messing
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Supriya G Mohile
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Chunkit Fung
- Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
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24
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Johnson DC, Greene PS, Nielsen ME. Surgical advances in bladder cancer: at what cost? Urol Clin North Am 2015; 42:235-52, ix. [PMID: 25882565 DOI: 10.1016/j.ucl.2015.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Bladder cancer is the most expensive cancer to treat from diagnosis to death. Frequent disease recurrence, intense follow-up, and expensive, invasive techniques for diagnosis and treatment drive these costs for non-muscle invasive bladder cancer. Fluorescence cystoscopy increases the detection of superficial bladder cancer and reduces costs by improving the quality of resection and reducing recurrences. Radical cystectomy with intestinal diversion is the mainstay of treatment of invasive disease; however it is associated with substantial cost and morbidity. Increased efforts to improve the surgical management of bladder cancer while reducing the cost of treatment are increasingly necessary.
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Affiliation(s)
- David C Johnson
- Department of Urology, University of North Carolina, School of Medicine, 2113 Physician's Office Building, 170 Manning Drive, CB 7235, Chapel Hill, NC 27599, USA.
| | - Peter S Greene
- Department of Urology, University of North Carolina, School of Medicine, 2113 Physician's Office Building, 170 Manning Drive, CB 7235, Chapel Hill, NC 27599, USA
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina, School of Medicine, 2113 Physician's Office Building, 170 Manning Drive, CB 7235, Chapel Hill, NC 27599, USA
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