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Xu C, Zou W, Wang Y, Liu X, Wang J. Bladder-sparing treatment for muscle-invasive bladder carcinoma using immune checkpoint inhibitors. Crit Rev Oncol Hematol 2023; 191:104137. [PMID: 37717879 DOI: 10.1016/j.critrevonc.2023.104137] [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: 02/22/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
Multimodal bladder preservation therapy is already an alternative for patients with muscle-invasive bladder cancer (MIBC) who are unable or unwilling to undergo radical cystectomy. Various bladder-preserving strategies that employ immune checkpoint inhibitors (ICIs) for MIBC have been investigated. There are three common modes of ICI-based bladder preservation therapy, of which the most studied is ICIs combined with chemoradiotherapy. The bladder-preserving strategy of ICIs combined with radiation has been investigated in patients who poorly tolerate chemotherapy. ICIs combined with chemotherapy have also been explored in patients who responded to neoadjuvant therapy with a clinical complete response. All the above-described strategies have shown promising efficacy and manageable safety profiles. However, the value of programmed death-ligand 1 (PD-L1) expression, tumor mutation burden and gene alterations for predicting the efficacy of immune-based bladder preservation therapy is still controversial. There remain some challenges for immune-based bladder preservation therapy, and large-sample randomized trials are needed.
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Affiliation(s)
- Chao Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China.
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Liu Y, Zhang H, Wen Z, Jiang Y, Huang J, Wang C, Chen C, Wang J, Bao E, Yang X. Simultaneous radical cystectomy and nephroureterectomy in the treatment of panurothelial carcinoma: a systematic review and single-arm meta-analysis. Front Oncol 2023; 13:1233125. [PMID: 37817773 PMCID: PMC10561089 DOI: 10.3389/fonc.2023.1233125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background Panurothelial carcinoma is a rare and aggressive malignancy that requires effective treatment strategies to enhance patient outcomes. Methods We conducted a systematic search of English publications in databases including PubMed, Embase, Cochrane Library, and Web of Science up to May 2023. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS) and the Methodological Quality and Synthesis of Case Series and Case Reports tool. Data statistics and analysis were performed using Stata 15.1 software (StataSE, USA). Results Six studies involving 339 patients were included in the analysis. Meta-analysis revealed that Simultaneous Radical Cystectomy and Nephroureterectomy had 2-year and 5-year overall survival rates of 68% (95% CI 60%-76%, I2 = 12.4%, P < 0.001) and 44% (95% CI 36%-53%, I2 = 0, P < 0.001), respectively. The 2-year and 5-year progression-free survival rates were 91% (95% CI 86%-95%, I2 = 95%, P < 0.001) and 65% (95% CI 58%-73%, I2 = 91.5%, P < 0.001), respectively. The 2-year and 5-year cancer-specific survival rates were 73% (95% CI 66%-81%, I2 = 16.7%, P < 0.001) and 57% (95% CI 49%-66%, I2 = 0, P < 0.001), respectively. Additionally, the incidence of minor complications was 19% (95% CI 15%-23%, P < 0.01), major complications was 49% (95% CI 34%-63%, P < 0.01), and the intraoperative blood transfusion rate was 53% (95% CI 44%-61%, P < 0.01). Conclusions Simultaneous radical cystectomy and nephroureterectomy represent feasible approaches for the treatment of Panurothelial carcinoma. Nonetheless, a comprehensive assessment of the surgical risks and benefits is imperative, and larger-scale prospective cohort studies are required to validate therapeutic efficacy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023426401.
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Affiliation(s)
- Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Huimin Zhang
- Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, Chengdu, China
| | - Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yu Jiang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Huang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chongjian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Caixia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiahao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Erhao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xuesong Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Fu Z, Tian Z, Chen Y, Jia Z, Wang C, Zhang X, Zhang W, Li G, Wei X, Huang Y. Analysis of the efficacy of a single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy. Eur J Med Res 2023; 28:273. [PMID: 37550747 PMCID: PMC10405402 DOI: 10.1186/s40001-023-01250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Radical cystectomy and urinary diversion are the standard surgical treatments for patients with muscle-invasive or high-risk, or recurrent non-muscle-invasive bladder cancer. Although this approach significantly prolongs patient survival, it can lead to postoperative complications. This study aims to compare the efficacy and complications of bilateral cutaneous ureterostomy with a single subumbilical stoma to those of cutaneous ureterostomy with two stomas and an ileal conduit as a means of urinary diversion after radical cystectomy. The findings of this study will provide valuable information for healthcare providers in selecting the appropriate urinary diversion method for their patients. METHODS The clinical data for 108 patients who received bilateral cutaneous ureterostomy with a single subumbilical stoma (ureterostomy with a single stoma group), cutaneous ureterostomy with two stomas (ureterostomy with two stomas group), or an ileal conduit (ileal conduit group) after radical cystectomy were retrospectively analysed. The operative time, pathological stage, survival status, perioperative complication rate, rate of successful first extubation, rehospitalization rate at 6 months after surgery,ostomy-related medical costs,and postoperative quality of life were compared between the three groups of patients. RESULTS A significant difference in the operative time was found between the three groups (P = 0.001). No significant differences in pathological stage, survival status, perioperative complication rate, rehospitalization rate at 6 months after surgery, or bladder cancer index (BCI) score were identified among the three groups. The difference in the successful first extubation rate between the three groups of patients was significant (P = 0.001). Significant differences in ostomy-related medical costs were observed among the three groups of patients (P = 0.006). CONCLUSION A single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy may result in shorter surgery time, increased success rates for initial catheter removal, and lower medical expenses. However, to confirm these findings, further prospective randomized clinical trials are necessary.
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Affiliation(s)
- Zhenyu Fu
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Urology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China
| | - Zhen Tian
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yongchang Chen
- Department of Urology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China
| | - Zongming Jia
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chengyu Wang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuefeng Zhang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weijie Zhang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Gang Li
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuedong Wei
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Yuhua Huang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Cochetti G, Paladini A, Del Zingaro M, Ciarletti S, Pastore F, Massa G, De Angelis L, Mearini E. Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications. Front Surg 2023; 10:1157684. [PMID: 37383384 PMCID: PMC10293791 DOI: 10.3389/fsurg.2023.1157684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Radical cystectomy with pelvic lymph node dissection is the gold standard treatment for non-metastatic muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. For years, the traditional open surgery approach was the only viable option. The widespread of robotic surgery led to its employment also in radical cystectomy to reduce complication rates and improve functional outcomes. Regardless of the type of approach, radical cystectomy is a procedure with high morbidity and not negligible mortality. Data available in the literature show how the use of staplers can offer valid functional outcomes, with an acceptable rate of complications shortening the operative time. The aim of our study was to describe the perioperative outcomes and complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) using a mechanical stapler. Material and methods From January 2015 to May 2021, we enrolled patients who underwent RARC with pelvic node dissection and stapled ICUD (ileal conduit or ileal Y-shaped neobladder according to the Perugia ileal neobladder) in our high-volume center. Demographic features, perioperative outcomes and early (≤30 days) and late (>90 days) post-operative complications according to the Clavien-Dindo classification, were recorded for each patient. We also analyzed the potential linear correlation between demographic, pre-operative as well as operative features and the risk of post-operative complications. Results Overall, 112 patients who underwent RARC with ICUD were included with a minimum follow-up of 12 months. Intracorporeal Perugia ileal neobladder was performed in 74.1% of cases while ileal conduit was performed in 25.9%. The mean operative time, estimated intraoperative blood loss, and LOS were 289.1 ± 59.7 min, 390.6 ± 186.2 ml, and 17.5 ± 9.8 days, respectively. Early minor and major complications accounted for 26.7% and 10.8%, respectively. Overall late complications were 40.2%. The late most common complications were hydronephrosis (11.6%) and urinary tract infections (20.5%). Stone reservoir formation occurred in 2.7% of patients. Major complications occurred in 5.4%. In the sub-analysis, the mean operative time and the estimated blood loss improved significantly from the first 56 procedures to the last ones. Conclusion RARC with ICUD performed by mechanical stapler is a safe and effective technique. Stapled Y-shaped neobladder did not increase the complication rate.
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Britton CJ, Gottlich HC, Tarrell RF, Thapa P, Joyce DD, Shah PH, Sharma V, Boorjian SA, Frank I, Potretzke AM. Perioperative and Oncologic Outcomes Associated with Simultaneous Radical Cystectomy and Nephroureterectomy. Urology 2023; 172:149-156. [PMID: 36436677 DOI: 10.1016/j.urology.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the perioperative and oncologic outcomes associated with RCNU to a matched cohort undergoing RC alone. Simultaneous radical cystectomy and nephroureterectomy (RCNU) for synchronous upper tract and bladder urothelial carcinoma is an uncommon procedure. Sparse literature exists comparing outcomes in patients treated with radical cystectomy (RC) alone versus RCNU. METHODS Adults treated with RCNU for urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC) between 1980 and 2020 were identified. Patients were matched 2:1 to patients undergoing RC alone for UCB based on age (+/- 5 years), gender, BMI (+/- 5), Charlson Comorbidity Index, pathologic staging (stage ≤pT2 vs >pT2), and receipt of neoadjuvant chemotherapy. Outcomes included overall survival (OS), recurrence free survival (RFS), cancer specific survival (CSS), 30-day complications, length of stay (LOS), operative time, and estimated blood loss (EBL). RESULTS A total of 39 patients undergoing RCNU were identified and matched to 74 patients undergoing RC. There were no significant differences in LOS, EBL, or 30-day complication rates. Operative time was significantly longer in the RC cohort. OS (HR 0.58, CI 0.35-0.97, P = .036) was significantly better for patients undergoing RC alone, while no significant difference was noted in RFS (HR 0.65, 0.34-1.24) and CSS (HR 0.58, CI 0.31-1.08, P = .08). CONCLUSIONS Patients undergoing RCNU had significantly lower OS compared to a matched group of patients undergoing RC alone. Perioperative outcomes between the groups did not differ significantly. This data can inform patient counseling for treatment of this rare disease state.
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Affiliation(s)
| | | | - Robert F Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Lyu Q, Nie Y, Yuan J, Wang D. Causes of death in female patients with bladder cancer after local tumor excision and radical cystectomy: a contemporary, US population-based analysis. Eur J Med Res 2022; 27:230. [PMID: 36329537 PMCID: PMC9635151 DOI: 10.1186/s40001-022-00873-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Surgery is one of the most important treatments for bladder cancer, including local tumor excision and radical cystectomy. At present, studies on the causes of death for contemporary survivors, especially women, who have received different surgical treatments are limited. Therefore, the study used a population-based cohort study in the United States from 2000 to 2017 to analyze causes of death for women who underwent local tumor excision or radical cystectomy stratified by demographics and tumor stage. standardized mortality ratios (SMRs) were calculated based on general population data. In total, 24,040 female patients who underwent surgical treatments were assessed. Of those 20,780 patients undergoing local tumor excision, 36.6% died of bladder cancer, while 63.4% died of other causes. The risk of death from all causes increased in comparation with the general population (SMR 1.85; 95% CI 1.82-1.87), and the most common non-tumor cause of death was from heart diseases (16.2%; SMR 1.13; 95% CI 1.09-1.16). Among women who receive radical cystectomy, 82.3% of deaths occurred within 5 years after surgery. 66.9% deaths resulted from bladder cancer, and the risk of death from all causes significantly higher than that in the general people (SMR 4.67; 95% CI 4.51-4.84). Moreover, the risk of death from non- bladder cancer causes also increased, in particular, such as septicemia (SMR 3.09; 95% CI 2.13-4.34). Causes of death during bladder cancer survivorship after surgery vary by patient and tumor characteristics, and these data provide information regarding primary care for women during postoperative cancer survivorship.
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Affiliation(s)
- Qian Lyu
- Robot Minimally Invasive Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yu Nie
- Robot Minimally Invasive Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Jiazheng Yuan
- Robot Minimally Invasive Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Dong Wang
- Robot Minimally Invasive Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China.
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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Comparative performance of the different orthotopic urinary diversions. Curr Opin Urol 2022; 32:554-560. [DOI: 10.1097/mou.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Gabriel PÉ, Siebert M, Le Fouler A, Van Glabeke E, Trésallet C. Management of gastro-intestinal emergencies in patients with ileal conduit ureteral diversion. J Visc Surg 2022; 159:399-408. [PMID: 35690581 DOI: 10.1016/j.jviscsurg.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radical cystectomy with urinary deviation is performed increasingly in France. Ileal conduit ureteral diversion (ICUD), described by Bricker and widely used after this type of radical resection, leads to substantial anatomic modifications that are potential danger zones during subsequent gastro-intestinal or urinary tract operations. Injury to the urinary diversion apparatus can lead to disastrous complications in these patients who are often elderly and frail. General surgeons are most often called upon to re-operate these patients, either for an ICUD-related gastro-intestinal complication, or for an unrelated abdominal emergency that arises later (bowel obstruction, infection, cancer). During such operations, certain anatomic structures are particularly exposed to injury that may be irreversible, particularly, the mesentery of the ileal conduit and the left ureter. Approaching the right lower quadrant, the dissection of the ileo-ileal anastomosis or of the left mesocolon are the procedures or maneuvers that pose the most risk. A number of simple but effective preventive measures are available and must be known, such as to operate the patient with an urologist or to insert ureteral stents before surgery. Preoperative contrast-enhanced computed tomography with late phase urinary imaging is essential to assess the anatomic modifications and anticipate the operative procedural steps. Finally, one should not hesitate to disinsert the stoma and proceed with retrograde dissection, thus facilitating the identification of the ileal conduit, the mesentery and the ureters.
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Affiliation(s)
- P-É Gabriel
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne Hospital Group, AP-HP, 93000 Bobigny, France; Paris Seine-Saint-Denis University Hospitals (Paris 13), Sorbonne Paris Nord, Paris, France
| | - M Siebert
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne Hospital Group, AP-HP, 93000 Bobigny, France; Paris Seine-Saint-Denis University Hospitals (Paris 13), Sorbonne Paris Nord, Paris, France
| | - A Le Fouler
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne Hospital Group, AP-HP, 93000 Bobigny, France; Paris Seine-Saint-Denis University Hospitals (Paris 13), Sorbonne Paris Nord, Paris, France
| | - E Van Glabeke
- Inter-hospital Urology Federation of Seine Saint-Denis, CHI André-Grégoire, 93100 Montreuil, France
| | - C Trésallet
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne Hospital Group, AP-HP, 93000 Bobigny, France; Paris Seine-Saint-Denis University Hospitals (Paris 13), Sorbonne Paris Nord, Paris, France.
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Early and midterm complications of the continent catheterizable Indiana Pouch urinary diversion: A 7 year experience. Urology 2022; 167:229-233. [DOI: 10.1016/j.urology.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/15/2022]
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11
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Ayoub CH, Dakroub A, El-Asmar JM, Ali AH, Beaini H, Abdulfattah S, El Hajj A. Preoperative MELD score predicts mortality and adverse outcomes following radical cystectomy: analysis of American College of Surgeons National Surgical Quality Improvement Program. Ther Adv Urol 2022; 14:17562872221135944. [PMID: 36407007 PMCID: PMC9669693 DOI: 10.1177/17562872221135944] [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: 06/28/2022] [Accepted: 10/12/2022] [Indexed: 08/15/2023] Open
Abstract
Background The model for end-stage liver disease (MELD) has been widely used to predict the mortality and morbidity of various surgical procedures. Objectives We aimed to correlate a high preoperative MELD score with adverse 30-day postoperative complications following radical cystectomy. Design and Methods Patients who underwent elective, non-emergency radical cystectomy were identified from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2017. Patients were categorized according to a calculated MELD score. The primary outcomes of this study were 30-day postoperative mortality, morbidity, and length of hospital stay following radical cystectomy. For further sensitivity analysis, propensity score matching was used to yield a total of 1387 matched pairs and primary outcomes were also assessed in the matched cohort. Results Compared with patients with a MELD < 10, those with MELD ⩾ 10 had significantly higher rates of mortality [odds ratio (OR) = 1.71, p = 0.004], major complications (OR = 1.42, p < 0.001), and prolonged hospital stay (OR = 1.29, p < 0.001) on multivariate analysis. Following risk-adjustment for race, propensity-matched groups revealed that patients with MELD score ⩾ 10 were significantly associated with higher mortality (OR = 1.85, p = 0.008), major complications (OR = 1.34, p < 0.001), yet similar length of hospital stay (OR = 1.17, p = 0.072). Conclusion MELD score ⩾ 10 is associated with higher mortality and morbidity in patients undergoing radical cystectomy compared with lower MELD scores. Risk-stratification using MELD score may assist clinicians in identifying high-risk patients to provide adequate preoperative counseling, optimize perioperative conditions, and even consider nonsurgical alternatives.
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Affiliation(s)
- Christian Habib Ayoub
- Division of Urology, Department of Surgery,
American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Dakroub
- American University of Beirut Medical School,
American University of Beirut, Beirut, Lebanon
| | - Jose M. El-Asmar
- Division of Urology, Department of Surgery,
American University of Beirut Medical Center, Beirut, Lebanon
| | - Adel Hajj Ali
- Cleveland Clinic, Heart, Vascular &
Thoracic Institute, Cleveland, Ohio, USA
| | - Hadi Beaini
- American University of Beirut Medical School,
American University of Beirut, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School,
American University of Beirut, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery,
American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh,
Beirut 1107 2020, Lebanon
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Neighborhood Socioeconomic Disadvantage Associated With Increased 90-Day Mortality Following Radical Cystectomy. Urology 2021; 163:177-184. [PMID: 34974027 DOI: 10.1016/j.urology.2021.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine relationships between neighborhood socioeconomic disadvantage and outcomes following radical cystectomy (RC). MATERIALS AND METHODS A retrospective single institution study of consecutive RCs performed for bladder cancer between 2011 and 2019. Major complications, mortality and survival outcomes were compared using Cochran-Armitage or Kruskal-Wallis tests. Cox proportional hazards models were used for time-to-event analyses. RESULTS A total of 906 patients were included in analysis. Overall 90-day mortality was 2.98% (27/906). Ninety-day mortality rates observed in the least (first) and most (fourth) disadvantaged ADI quartiles were 0% (0/115) and 6.5% (12/185), respectively. Patients from the fourth quartile demonstrated worse overall survival and recurrence free survival than those in the first quartile. ADI quartile was positively associated with muscle invasive (P = .0006) and node positive (P = .042) disease. ADI percentile was an independent predictor for 90-day mortality (adjusted OR: 1.022, CI: 1.004-1.04, P = .015). CONCLUSION Higher rates of mortality and worse oncologic outcomes were observed for patients residing in the most disadvantaged quartile. ADI was associated with higher likelihood of 90-day mortality and may therefore be useful in patient counseling, risk stratification, and post-discharge management.
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Goodstein T, Wang SJ, Lee CT. Bladder preservation in urothelial carcinoma: current trends and future directions. Curr Opin Support Palliat Care 2021; 15:253-259. [PMID: 34726191 DOI: 10.1097/spc.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a contemporary rationale for bladder preservation as a treatment strategy for muscle-invasive urothelial carcinoma of the bladder. Although the standard of care for this important and serious clinical condition has been radical cystectomy augmented with neoadjuvant systemic chemotherapy, it is associated with substantial morbidity and quality of life (QoL) implications. This article explores the bladder sparing alternatives to radical cystectomy and urinary diversion to assist Urologists, Medical Oncologists, and Palliative Care providers in their informed decision making with patients. RECENT FINDINGS Bladder sparing strategies such as partial cystectomy and trimodality therapy offer long-term cancer outcomes comparable to radical cystectomy in carefully selected patients. Moreover, the toxicity profile in patients, having improved over time, is acceptable, including a low risk of salvage cystectomy. SUMMARY Bladder preservation therapy offers an alternative to radical cystectomy. In some patients, it can be done with curative intent and in others it can assist with symptom palliation. Bladder preservation can maintain QoL and provide similar oncologic outcomes to radical surgery, although randomized controlled trials have not been performed. Understanding patient selection is a critical step in balancing bladder preservation and cancer survival.
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Affiliation(s)
| | - Shang-Jui Wang
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio, USA
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Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Røder MA. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open 2021; 11:e043266. [PMID: 33853799 PMCID: PMC8054090 DOI: 10.1136/bmjopen-2020-043266] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these. DESIGN Systematic review. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC. CONCLUSION Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC. PROSPERO REGISTRATION NUMBER 104937.
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Affiliation(s)
- Sophia Liff Maibom
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
- Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
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15
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Radical Cystectomy. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Tholomier C, Souhami L, Kassouf W. Bladder-sparing protocols in the treatment of muscle-invasive bladder cancer. Transl Androl Urol 2020; 9:2920-2937. [PMID: 33457265 PMCID: PMC7807363 DOI: 10.21037/tau.2020.02.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
Bladder-sparing protocols (BSP) have been gaining widespread popularity as an attractive alternative to radical cystectomy (RC) for muscle-invasive bladder cancer. Unimodal therapies are inferior to multimodal regimens. The most promising regimen is trimodal therapy (TMT), which is a combination of maximal transurethral resection of bladder tumor (TURBT), radiotherapy, and chemotherapy. In appropriately selected patients (low volume unifocal T2 disease, complete TURBT, no hydronephrosis and no carcinoma-in-situ), comparable oncological outcomes to RC have been reported in large retrospective studies, with a potential improvement in overall quality of life (QOL). TMT also offers the possibility for definitive therapy for patients who are not surgically fit to undergo RC. Routine biopsy of previous tumor resection is recommended to assess response. Prompt salvage RC is required in non-responders and for recurrent muscle-invasive disease, while non-muscle-invasive recurrence can be managed conservatively with TURBT +/- intravesical BCG. Long-term follow-up consisting of routine cystoscopy, urine cytology, and cross-section imaging is required. Further studies are warranted to better define the role of neoadjuvant or adjuvant chemotherapy in the setting of TMT. Finally, future research on predictive markers of response to TMT and on the integration of immunotherapy in bladder sparing protocols is ongoing and is highly promising.
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Affiliation(s)
- Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
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Abstract
IMPORTANCE Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. OBSERVATIONS Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease. CONCLUSIONS AND RELEVANCE Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non-muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.
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Affiliation(s)
- Andrew T Lenis
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Patrick M Lec
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | | | - M D Mshs
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
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Hockman L, Bailey J, Sanders J, Muzzey C, Wakefield M, Christensen A, Murray K. A Qualitative Assessment of Patient Satisfaction with Radical Cystectomy for Bladder Cancer at a Single Institution: How Can We Improve? Res Rep Urol 2020; 12:447-453. [PMID: 33117744 PMCID: PMC7550214 DOI: 10.2147/rru.s269405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate patient satisfaction (with emphasis on preoperative education) with radical cystectomy for bladder cancer at our institution, the University of Missouri Hospital, qualitatively in order to identify specific areas where improvements can be made. MATERIALS AND METHODS We developed a patient survey that used open-ended questions to identify positive and negative experiences that contributed to patient satisfaction. We administered the survey to radical cystectomy patients who met inclusion criteria and agreed to participate. We recorded, transcribed and qualitatively coded the responses. We identified four themes under which both positive and negative responses were placed, and constructed two diagrams to better illustrate contributors to patient experience and satisfaction. RESULTS We identified 25 patients who met inclusion criteria. Of those, 13 participated in the survey. Regarding overall experience, 92.3% of patients rated their care as excellent or good. Regarding preoperative education, 76.9% of patients reported they definitely or somewhat received enough information on what to expect after surgery, and 76.9% definitely received enough guidance on how to care for themselves after surgery. From qualitative coding of patient responses to open-ended questions, we identified preoperative preparation, delivery of care, caregiver availability, and patient-centered care as themes that contributed positively and negatively to patient experience. CONCLUSION Although the overall patient satisfaction could be perceived as high (92.3%), qualitative analysis revealed several areas where improvements can be made to improve patient experience with radical cystectomy at our institution. As previously expected, preoperative preparation was a contributor.
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Affiliation(s)
- Lukas Hockman
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Bailey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Sanders
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Catherine Muzzey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Mark Wakefield
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Amy Christensen
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Katie Murray
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Corona LE, Singhal U, Hafez K, Herrel LA, Kaffenberger SD, Montgomery JS, Morgan TM, Weizer AZ, Qin Y, Ambani SN. Rethinking the one-size-fits-most approach to venous thromboembolism prophylaxis after radical cystectomy. Urol Oncol 2020; 38:797.e1-797.e6. [PMID: 32624425 DOI: 10.1016/j.urolonc.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/10/2020] [Accepted: 05/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Empirically dosed enoxaparin is routinely given in the postoperative period for venous thromboembolism (VTE) prophylaxis after radical cystectomy (RC). Patient-specific factors may alter its pharmacokinetics, and it is unclear whether this leads to levels sufficient for antithrombosis. We sought to evaluate variability of anti-factor Xa levels in a cohort of RC patients receiving perioperative enoxaparin prophylaxis. MATERIAL AND METHODS Patients undergoing RC at a single institution were placed on a postoperative pathway that included enoxaparin. An anti-factor Xa level was drawn 2 to 4 hours after the third dose. The target range for prophylaxis was 0.3 IU/ml to 0.5 IU/ml. RESULTS The primary outcome was anti-factor Xa level. Demographics, operative time, hospital course, and 30-days post-operative VTE were compared by anti-factor Xa level group using univariate and multivariable analyses. Between January 2018 and 2019, 107 RC patients remained on pathway and were included in our analysis. Sixty-five (61%) were below target range for VTE prophylaxis. A single VTE event (0.9%) occurred in a subprophylactic individual. The subprophylactic group had a significantly higher body mass index (P < 0.01) than those within target range. CONCLUSIONS Higher body mass index was associated with subprophylactic enoxaparin dosing after RC. Nearly two-thirds of patients had below target anti-factor Xa levels. This suggests that dosing could be further individualized, but given the low incidence of VTE, implications of dose-adjusted prophylaxis on VTE prevention remain unknown.
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Affiliation(s)
- Lauren E Corona
- University of Michigan, Department of Urology, Ann Arbor, MI.
| | - Udit Singhal
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Khaled Hafez
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | | | | | - Todd M Morgan
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Alon Z Weizer
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Yongmei Qin
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Sapan N Ambani
- University of Michigan, Department of Urology, Ann Arbor, MI
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Mcchesney SL, Canter DJ, Monlezun DJ, Green H, Margolin DA. Modified Frailty Index Predicts Postoperative Outcomes in Patients Undergoing Radical Pelvic Surgery. Am Surg 2020. [DOI: 10.1177/000313482008600222] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Pre-operative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality ( P < 0.0001) and Clavien-Dindo grade IV complications ( P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.
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Affiliation(s)
- Shannon L. Mcchesney
- Department of Colon and Rectal Surgery, The Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Daniel J. Canter
- Department of Urology, The Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Dominique J. Monlezun
- Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather Green
- Department of Colon and Rectal Surgery, The Ochsner Clinic Foundation, New Orleans, Louisiana
| | - David A. Margolin
- Department of Colon and Rectal Surgery, The Ochsner Clinic Foundation, New Orleans, Louisiana
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21
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Tsai LH, Li WJ, Chen GH, Hsieh PF, Chang CH. Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion: Two case reports. Medicine (Baltimore) 2019; 98:e17222. [PMID: 31593079 PMCID: PMC6799691 DOI: 10.1097/md.0000000000017222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC). PATIENT CONCERNS A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit. DIAGNOSIS Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion. INTERVENTIONS The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found. OUTCOMES Both patients recovered smoothly after second operation. LESSONS The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.
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Banerjee S, Semper K, Skarparis K, Naisby J, Lewis L, Cucato G, Mills R, Rochester M, Saxton J. Patient perspectives of vigorous intensity aerobic interval exercise prehabilitation prior to radical cystectomy: a qualitative focus group study. Disabil Rehabil 2019; 43:1084-1091. [PMID: 31411925 DOI: 10.1080/09638288.2019.1651907] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Preoperative cardiopulmonary fitness is increasingly being recognized as an important factor influencing postoperative recovery outcomes in cancer patients. The aim of this study was to explore patient perspectives of preoperative high intensity aerobic interval exercise before radical cystectomy. MATERIALS AND METHODS Focus groups involving a purposive convenience sample of patients with bladder cancer (N = 14; mean age ± SD: 72.3 ± 6.0 years) were undertaken in a hospital education department. Data were analyzed using Framework analysis. RESULTS Participants identified physical (e.g., fitness) psychological (e.g., preparing for their operation) and social (e.g., peer support) benefits of the program. Key motivational factors for engaging in exercise prehabiliation were identified as social support, previous exercise experience and objective measures of progression. The need for clear information from healthcare providers to ensure that patients are adequately prepared for sessions was highlighted. CONCLUSIONS This qualitative study provides new insights into the perspectives and experiences of patients with bladder cancer regarding participation in preoperative vigorous intensity aerobic exercise. The study yielded novel perceptions on the physical, psychological and social health benefits accruing from the exercise program and patient views on program design features, which are important for informing future interventions and implementation strategies.IMPLICATIONS FOR REHABILITATIONA preoperative high intensity aerobic interval exercise program before radical cystectomy provides physical, psychological and social benefits to individuals living with bladder cancer.Supervised exercise, objective improvement, and peer and family support all contribute to motivation to engage with preoperative high intensity aerobic interval exercise.Individuals may require support post-radical cystectomy in order to continue with exercise due to the uncertainty around this.
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Affiliation(s)
- Srijit Banerjee
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Kelly Semper
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Katy Skarparis
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Liane Lewis
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Gabriel Cucato
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Robert Mills
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Mark Rochester
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - John Saxton
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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Zhu Z, Wang X, Wang J, Wang S, Fan Y, Fu T, Cao S, Zhang X. Preoperative predictors of early death risk in bladder cancer patients treated with robot-assisted radical cystectomy. Cancer Med 2019; 8:3447-3452. [PMID: 31091022 PMCID: PMC6601570 DOI: 10.1002/cam4.2237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/07/2019] [Accepted: 04/20/2019] [Indexed: 12/12/2022] Open
Abstract
Background Early identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients. Methods A total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected. Results Median follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC. Conclusion Age and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.
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Affiliation(s)
- Zhaowei Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xiaojing Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiange Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Shengzheng Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Yafeng Fan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Tianlong Fu
- Department of Urology, Zhengzhou Central Hospital, Zhengzhou, PR China
| | - Songqiang Cao
- Department of Urology, Huaihe Hospital of Henan University, Kaifeng, PR China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Leow JJ, Bedke J, Chamie K, Collins JW, Daneshmand S, Grivas P, Heidenreich A, Messing EM, Royce TJ, Sankin AI, Schoenberg MP, Shipley WU, Villers A, Efstathiou JA, Bellmunt J, Stenzl A. SIU–ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer. World J Urol 2019; 37:61-83. [DOI: 10.1007/s00345-018-2606-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
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25
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Violette PD, Lavallée LT, Kassouf W, Gross PL, Shayegan B. Canadian Urological Association guideline: Perioperative thromboprophylaxis and management of anticoagulation. Can Urol Assoc J 2018; 13:105-114. [PMID: 30575517 DOI: 10.5489/cuaj.5828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Philippe D Violette
- Department of Health Research Methods Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Luke T Lavallée
- The Ottawa Hospital and Ottawa Hospital Research Institute, Division of Urology, Department of Surgery, The University of Ottawa, Ottawa, ON, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Peter L Gross
- Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
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Alvimopan usage increasing following radical cystectomy. World J Urol 2018; 37:1151-1155. [DOI: 10.1007/s00345-018-2476-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/03/2018] [Indexed: 02/05/2023] Open
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Krishnan N, Li B, Jacobs BL, Ambani SN, Borza T, He C, Hollenbeck BK, Morgan T, Hafez KS, Weizer AZ, Montgomery JS, Lee CT, Lesse O, Lavieri MS, Helm JE, Skolarus TA. The Fate of Radical Cystectomy Patients after Hospital Discharge: Understanding the Black Box of the Pre-readmission Interval. Eur Urol Focus 2018; 4:711-717. [DOI: 10.1016/j.euf.2016.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
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28
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Murray KS, Prunty M, Henderson A, Haden T, Pokala N, Ge B, Wakefield M, Petroski GF, Mehr DR, Kruse RL. Functional Status in Patients Requiring Nursing Home Stay After Radical Cystectomy. Urology 2018; 121:39-43. [PMID: 30076943 DOI: 10.1016/j.urology.2018.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/25/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the postoperative period. METHODS Patients undergoing RC were identified in a novel database of patients with at least two NH assessments linked with Medicare inpatient claims. The NH assessment included the Minimum Data Set (MDS)-ADL Long Form (0-28; a higher score equals greater impairment), which quantifies ADLs. Paired t-tests and chi-squared analysis were used for comparisons. RESULTS We identified 471 patients that underwent RC and had at least one MDS-ADL assessment. In total, 245 patients lived elsewhere prior to RC and went to an NH after RC, while 122 patients lived in an NH before and after RC. Mean age of the population was 80.7 years (standard deviation 5.7). Of the 245 patients who did not live in a facility before RC, 68% of patients were discharged directly to an NH and 31% were discharged to another location before NH. There was no difference in MDS-ADL score between these groups (16.4 vs 15.0, P = .09). Among the patients who lived in an NH before and after RC, the mean pre- and post-operative MDS-ADL scores were significantly different (12.1 vs 16.6, P<.0001). CONCLUSION ADLs, as measured by the MDS-ADL Long Form score, worsen after RC. This should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
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Affiliation(s)
- Katie S Murray
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Megan Prunty
- University of Missouri School of Medicine, Columbia, MO
| | - Alex Henderson
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Tyler Haden
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Naveen Pokala
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Bin Ge
- Office of Medical Research, University of Missouri, Columbia, MO
| | - Mark Wakefield
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | | | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
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Schomburg JL, Krishna S, Cotter KJ, Soubra A, Rao A, Konety BR. Preoperative Incidence of Deep Venous Thrombosis in Patients With Bladder Cancer Undergoing Radical Cystectomy. Urology 2018; 116:120-124. [DOI: 10.1016/j.urology.2018.01.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 12/12/2022]
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Lim C, Cohn JR, Cohn JA. Can a diagnosis of bladder cancer motivate positive lifestyle changes-and prevent recurrent disease? Transl Androl Urol 2018; 7:S242-S245. [PMID: 29928624 PMCID: PMC5989117 DOI: 10.21037/tau.2018.04.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Caitlin Lim
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - John R Cohn
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua A Cohn
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA.,Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Johnson SC, Smith ZL, Golan S, Rodriguez JF, Pearce SM, Smith ND, Steinberg GD. Perioperative and long-term outcomes after radical cystectomy in hemodialysis patients. Urol Oncol 2018; 36:237.e19-237.e24. [PMID: 29395954 DOI: 10.1016/j.urolonc.2017.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/06/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients on hemodialysis have an increased risk of developing advanced stage bladder cancer. They also have a significant risk of noncancer-related mortality. Radical cystectomy (RC) is the standard of care for nonmetastatic muscle-invasive bladder cancer, however little is known regarding outcomes in this population. MATERIALS AND METHODS The United States Renal Disease System database was used to identify all patients on hemodialysis who underwent RC for bladder cancer in the United States between 1984 and 2013. A total of 985 patients were identified for analysis. Perioperative outcomes were evaluated. Competing risks analysis was used to estimate overall and cancer-specific mortality along with factors associated with death. RESULTS Median hospital length of stay was 10 days and 43.1% of patients experienced a complication. Mortality within 30 days was 9.3%. Overall mortality at 1, 3, and 5 years was 51.7%, 77.3%, and 87.9%, respectively. Cancer-specific mortality at 1, 3, and 5 years was 12.3%, 18.4%, and 19.7%, respectively. Age, diabetes, and cerebrovascular disease were independently associated with overall mortality, while performance of urinary diversion was associated with a protective effect. Active smoking was the sole risk factor for cancer-specific mortality. CONCLUSIONS RC in dialysis patients is associated with significant morbidity and mortality, with less than 15% overall survival at 5 years. Older patients, and those with a history of diabetes or cerebrovascular disease, are at an increased risk of mortality.
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Affiliation(s)
- Scott C Johnson
- Medical College of Wisconsin, Department of Urology, Milwaukee, WI.
| | - Zachary L Smith
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL
| | - Shay Golan
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL
| | - Joseph F Rodriguez
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL
| | - Shane M Pearce
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL
| | - Norm D Smith
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL
| | - Gary D Steinberg
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL
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Schomburg J, Krishna S, Soubra A, Cotter K, Fan Y, Brown G, Konety B. Extended outpatient chemoprophylaxis reduces venous thromboembolism after radical cystectomy. Urol Oncol 2018; 36:77.e9-77.e13. [DOI: 10.1016/j.urolonc.2017.09.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/04/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
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33
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Park J, Jeong H. Morbidity, Mortality, and Survival for Radical Cystectomy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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34
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Temporal trends in perioperative morbidity for radical cystectomy using the National Surgical Quality Improvement Program database. Urol Oncol 2017; 35:659.e13-659.e19. [DOI: 10.1016/j.urolonc.2017.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/21/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
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Abstract
BACKGROUND Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system. OBJECTIVE To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost. METHODS A literature search of multiple electronic databases was undertaken. Manuscripts including patients undergoing radical cystectomy were chosen based on predefined criteria with an emphasis on randomized controlled trials and cohort studies. Strength of evidence for each study that met inclusion criteria was assessed based on the risk of bias, consistency, directness, and precision. RESULTS Database searches resulted in 1,236 potentially relevant articles. A total of 485 articles were selected for full-text dual review and 106 studies in 52 publications met the inclusion criteria. CONCLUSION The utilization of enhanced recovery pathways with the goal of improving overall patient morbidity and mortality is well supported in the literature, however standardization of implementation and adherence across institutions is lacking, and their direct efficacy on reducing preventable treatment related expenditures is unconfirmed.
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Affiliation(s)
- Ian Maloney
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Daniel C. Parker
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Michael S. Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Sanjay Patel
- Department of Urology, The University of Oklahoma Health Sciences Center and The Stephenson Cancer Center, Oklahoma City, OK, USA
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36
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Contreras-García R, García-Perdomo H, García-Ángel A. Mortalidad perioperatoria en pacientes sometidos a cistectomía radical en un hospital universitario. Rev Urol 2017. [DOI: 10.1016/j.uroco.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Pariser JJ, Pearce SM, Anderson BB, Packiam VT, Prachand VN, Smith ND, Steinberg GD. Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous Heparin. J Urol 2017; 197:302-307. [DOI: 10.1016/j.juro.2016.08.090] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Joseph J. Pariser
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Shane M. Pearce
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Blake B. Anderson
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Vignesh T. Packiam
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Vivek N. Prachand
- Section of General Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Norm D. Smith
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Gary D. Steinberg
- Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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38
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Forrest JB. Editorial Commentary. UROLOGY PRACTICE 2016; 3:466-467. [PMID: 37592574 DOI: 10.1016/j.urpr.2016.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- John B Forrest
- Surgical Services and Surgical Oncology, St. John Medical Center, Tulsa, Oklahoma
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39
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Yang LS, Shan BL, Shan LL, Chin P, Murray S, Ahmadi N, Saxena A. A systematic review and meta-analysis of quality of life outcomes after radical cystectomy for bladder cancer. Surg Oncol 2016; 25:281-97. [DOI: 10.1016/j.suronc.2016.05.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
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40
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Chappidi MR, Kates M, Patel HD, Tosoian JJ, Kaye DR, Sopko NA, Lascano D, Liu JJ, McKiernan J, Bivalacqua TJ. Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy. Urol Oncol 2016; 34:256.e1-6. [PMID: 26899289 PMCID: PMC4875870 DOI: 10.1016/j.urolonc.2015.12.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the modified frailty index (mFI) as a preoperative predictor of postoperative complications following radical cystectomy (RC) in patients with bladder cancer. MATERIALS AND METHODS Patients undergoing RC were identified from the National Surgical Quality Improvement Program participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to the National Surgical Quality Improvement Program comorbidities and activities of daily livings. The mFI groups were determined by the number of risk factors per patient (0, 1, 2, and≥3). Univariable and multivariable regression were performed to determine predictors of Clavien 4 and 5 complications, and a sensitivity analysis was performed to determine the mFI value that would be a significant predictor of Clavien 4 and 5 complications. RESULTS Of the 2,679 cystectomy patients identified, 843 (31%) of patients had an mFI of 0, 1176 (44%) had an mFI of 1, 555 (21%) had an mFI of 2, and 105 (4%) had an mFI≥3. Overall, 1585 (59%) of patients experienced a Clavien complication. When stratified at a cutoff of mFI≥2, the overall complication rate was not different (61.7% vs. 58.3%, P = 0.1), but the mFI2 or greater group had a significantly higher rate of Clavien grade 4 or 5 complications (14.6% vs. 8.3%, P<0.001) and overall mortality rate (3.5% vs. 1.8%, P = 0.01) in the 30-day postoperative period. The multivariate logistic regression model showed independent predictors of Clavien grade 4 or 5 complications were age>80 years (odds ratio [OR] = 1.58 [1.11-2.27]), mFI2 (OR = 1.84 [1.28-2.64]), and mFI3 (OR = 2.58 [1.47-4.55]). CONCLUSIONS Among patients undergoing RC, the mFI can identify those patients at greatest risk for severe complications and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, preoperative risk stratification is crucial to inform decision-making about surgical candidacy.
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Affiliation(s)
- Meera R Chappidi
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jeffrey J Tosoian
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Deborah R Kaye
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nikolai A Sopko
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Danny Lascano
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jen-Jane Liu
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - James McKiernan
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
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41
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Doiron RC, Booth CM, Wei X, Siemens DR. Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population-based study. BJU Int 2016; 118:714-722. [DOI: 10.1111/bju.13443] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - Christopher M. Booth
- Department of Oncology; Queen's University; Kingston ON Canada
- Department of Public Health Sciences; Queen's University; Kingston ON Canada
- Division of Cancer Care and Epidemiology; Queen's University Cancer Research Institute; Kingston ON Canada
| | - Xuejiao Wei
- Division of Cancer Care and Epidemiology; Queen's University Cancer Research Institute; Kingston ON Canada
| | - D. Robert Siemens
- Department of Urology; Queen's University; Kingston ON Canada
- Department of Oncology; Queen's University; Kingston ON Canada
- Division of Cancer Care and Epidemiology; Queen's University Cancer Research Institute; Kingston ON Canada
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Morales A, Cohen Z. Mycobacterium phleicell wall-nucleic acid complex in the treatment of nonmuscle invasive bladder cancer unresponsive to bacillus Calmette-Guerin. Expert Opin Biol Ther 2016; 16:273-83. [DOI: 10.1517/14712598.2016.1134483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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43
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Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography. Arab J Urol 2015; 14:37-43. [PMID: 26966592 PMCID: PMC4767786 DOI: 10.1016/j.aju.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/13/2015] [Accepted: 11/24/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To detect the incidence of immediate postoperative deep vein thrombosis (DVT) using screening lower extremity ultrasonography (US) in patients undergoing radical cystectomy (RC) and to determine the rate of symptomatic pulmonary embolism (PE) after RC and identify risk factors for venous thromboembolic (VTE) events in a RC population. PATIENTS AND METHODS We performed a retrospective review of prospective data collected on patients who underwent RC between July 2008 and January 2012. These patients underwent screening US at 2/3 days after RC to determine the rate of asymptomatic DVT. A chart review was completed to identify those who had a symptomatic PE. Univariate and multivariable analysis was used to identify risk factors associated with DVT, PE and total VTE events. RESULTS In all, 221 patients underwent RC and asymptomatic DVT was identified in 21 (9.5%) on screening US. Nine (4.5%) developed symptomatic PE at a median of 9 days, of which no patients had positive lower extremity US postoperatively. Increased length of hospital stay, increased estimated blood loss, and lower body mass index were linked to risk of PE, and only a previous history of DVT was associated with postoperative DVT. CONCLUSION Patients who undergo RC are at high-risk for thromboembolic events and multimodal prophylaxis should be administered. Clinicians should be especially vigilant in those who demonstrate factors associated with higher risk for VTE events.
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Knight BA, Potretzke AM, Larson JA, Bhayani SB. Comparing Expert Reported Outcomes to National Surgical Quality Improvement Program Risk Calculator-Predicted Outcomes: Do Reporting Standards Differ? J Endourol 2015; 29:1091-9. [DOI: 10.1089/end.2015.0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- B. Alexander Knight
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron M. Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A. Larson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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45
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Daneshmand S, Lerner SP. Radical cystectomy. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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46
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Potretzke AM, Wong KS, Shi F, Christensen W, Downs TM, Abel EJ. Highest risk of symptomatic venous thromboembolic events after radical cystectomy occurs in patients with obesity or nonurothelial cancers. Urol Ann 2015; 7:355-60. [PMID: 26229325 PMCID: PMC4518374 DOI: 10.4103/0974-7796.152050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/24/2014] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Venous thromboembolism (VTE) is a common cause of postoperative morbidity and mortality in cystectomy patients. AIMS The aim of this study is to identify variables associated with risk of developing deep venous thrombosis (DVT) or pulmonary embolism (PE) within 90 days after radical cystectomy (RC). SETTING AND DESIGN Retrospective chart review of patients undergoing RC from 2004 to 2011 at the University of Wisconsin. SUBJECTS AND METHODS Clinical variables collected for all RC patients. All patients received mechanical prophylaxis, and routine heparin prophylaxis began in 2010. STATISTICAL ANALYSIS USED Univariate and multivariate analyses were used to evaluate VTE association with known risk factors. RESULTS A total of 241 patients were identified with median age of 67.1 (interquartile range: 57.8-74.3) years. Body mass index (BMI) was ≥30 in 36.8% of patients. Median blood loss was 950 (600-1500) mL and 157/241 (65.2%) patients received a blood transfusion. CONCLUSIONS Patients with BMI ≥30 or nonurothelial cancer are at highest risk for postoperative VTE and should be considered for extended heparin prophylaxis.
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Affiliation(s)
- Aaron M Potretzke
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kelvin S Wong
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Fangfang Shi
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - William Christensen
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Tracy M Downs
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - E Jason Abel
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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47
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Rosario DJ. Mortality Following Radical Cystectomy: A Good Start, but How Low Can We Go? Eur Urol 2015; 67:1063-1065. [DOI: 10.1016/j.eururo.2015.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/09/2015] [Indexed: 11/29/2022]
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48
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Aziz A, May M, Burger M, Palisaar RJ, Trinh QD, Fritsche HM, Rink M, Chun F, Martini T, Bolenz C, Mayr R, Pycha A, Nuhn P, Stief C, Novotny V, Wirth M, Seitz C, Noldus J, Gilfrich C, Shariat SF, Brookman-May S, Bastian PJ, Denzinger S, Gierth M, Roghmann F. Prediction of 90-day Mortality After Radical Cystectomy for Bladder Cancer in a Prospective European Multicenter Cohort. Eur Urol 2014; 66:156-63. [DOI: 10.1016/j.eururo.2013.12.018] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Autran Gomez AM, Clarke C, Smith D, Yutkin V, Alzahrani A, Izawa JI. Is postoperative epidural analgesia better than patient-controlled analgesia for radical cystectomy? JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813500954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to evaluate postoperative epidural analgesia (EPA) and intravenous patient-controlled analgesia (PCA) in terms of morbidity and mortality in patients undergoing radical cystectomy for bladder cancer. Methods: A retrospective study on patients undergoing radical cystectomy for clinical Tis-4N0M0 urothelial carcinoma of the bladder was performed. Patients were separated into two groups: primary EPA or PCA for postoperative analgesia. The surgical complication severity was determined according to the Clavien system. Mann-Whitney U tests, χ2 with Yates’ correction, or Fisher’s exact test were used. Predictive risk factors were explored using univariable and multivariable Cox regression models. Results: Of the 274 patients studied, 209 (76%) received EPA and 65 (24%) had PCA. Baseline balance was observed. Similar complication rates were observed between the EPA (36%) and PCA (34%) ( p=0.382). Patients greater than 70 years of age had more complications (35% vs 21%, p=0.002). PCA patients had higher rates of high-grade complications compared with EPA patients [40% vs 20% ( p=0.0007)]. Only age at time of surgery ( p=0.032) was associated with complications. Patients with pulmonary disease had a higher risk of complications ( p=0.001). EPA or PCA were not predictors for overall survival. Conclusions: There does not appear to be a significant difference in terms of morbidity or mortality between EPA and PCA following radical cystectomy (RC). Rare, catastrophic complications specific to EPA may occur. Standardized reporting of surgical complications is essential to compare studies and appropriately counsel patients.
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Affiliation(s)
| | - Colin Clarke
- Department of Anesthesia, Western University, Canada
| | - David Smith
- Department of Anesthesia, Western University, Canada
| | | | | | - Jonathan I Izawa
- Departments of Surgery, Oncology and Pathology, Western University, Canada
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50
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Kates M, Gorin MA, Deibert CM, Pierorazio PM, Schoenberg MP, McKiernan JM, Bivalacqua TJ. In-hospital death and hospital-acquired complications among patients undergoing partial cystectomy for bladder cancer in the United States. Urol Oncol 2013; 32:53.e9-14. [PMID: 24239467 DOI: 10.1016/j.urolonc.2013.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 08/17/2013] [Accepted: 08/19/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Partial cystectomy (PC) is a therapeutic option for select patients with bladder cancer, but its associated perioperative risks and costs are unknown. We estimated annual rates of PC in a nationally representative sample of hospitals, and analyzed whether hospital volume affects postoperative outcomes and costs in patients undergoing PC. METHODS From the Nationwide Inpatient Sample, we selected a weighted cohort of patients with bladder cancer who underwent PC between 2002 and 2008. Differences in length of stay, charges, and clinical outcomes were calculated based on operative volume, and univariate and multivariate regression models were fitted to predict in-hospital mortality (IHM) and hospital-acquired conditions. RESULTS A total of 10,780 patients with bladder cancer who underwent PC were identified with an annual rate between 1457 and 1628 cases. IHM rates were 1.8%, constituting 195 patients (between 9 and 46 annually). A total of 417 patients (3.9%) experienced a "never event" complication, which Medicare no longer reimburses. The mean annual hospital volume of patients who died was 1.7 cases/y compared with 2.4 cases/y among those without fatal complications. No cases of IHM were identified among hospitals performing at least 5 partial cystectomies/y. In a multivariate regression model increased hospital volume was independently associated with decreased mortality (odds ratio = 0.70, 95% confidence interval; 0.60-0.80). CONCLUSIONS Approximately 1 in 25 patients undergoing PC experience a hospital-acquired complication, and nearly 1 in 50 die as a result of the operation. For each additional case a hospital performs annually, the risk of IHM decreases by 30%.
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Affiliation(s)
- Max Kates
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Michael A Gorin
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mark P Schoenberg
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD
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