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Yasuda Y, Numao N, Fujiwara R, Takemura K, Yoneoka Y, Oguchi T, Yamamoto S, Yonese J. Surgical outcomes and predictive value for major complications of robot-assisted radical cystectomy of real-world data in a single institution in Japan. Int J Urol 2024; 31:724-729. [PMID: 38477173 DOI: 10.1111/iju.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The objective of the study was to describe the surgical outcome of robot-assisted radical cystectomy and predictive factors for major complications in real-world clinical practice at a single institution in Japan. METHODS We retrospectively analyzed 208 consecutive patients undergoing robot-assisted radical cystectomy at our institution between 2019 and 2023. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed. Postoperative complications were defined as minor complications (Clavien-Dindo grades 1-2) or major complications (grades 3-5). Predictors of complications were examined using multivariable logistic analysis. RESULTS Overall, 147 men and 61 women, median age 70 years (interquartile range, 62-77), were included in this study. Median operative time and estimated blood loss were 8.4 h and 185 mL, respectively; 11 patients (5%) received intraoperative blood transfusions. For urinary diversions, ileal conduit, neobladder, and cutaneous ureterostomy were performed in 153 (74%), 49 (24%), and 6 (3%) patients, respectively. Urinary diversions were primarily performed with extracorporeal urinary diversion. In total, 140 complications occurred in 111 patients (53%) within 30 days. Of these patients, 31 major complications occurred in 28 patients, and one perioperative death (0.5%) with a postoperative cardiovascular event. Multivariable analysis showed only prolonged operative time (odds ratio: 4.34, 95% confidence interval: 1.82-10.35, p < 0.01) was the independent risk factor for major complications. CONCLUSIONS This study reports surgical outcomes at our single institution. Prolonged operative time was a significant prognostic factor for major complications. As far as we know, this study reports the largest number of robot-assisted radical cystectomy cases at a single center in Japan.
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Affiliation(s)
- Yosuke Yasuda
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Noboru Numao
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Ryo Fujiwara
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Kosuke Takemura
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Yusuke Yoneoka
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Tomohiko Oguchi
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Junji Yonese
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
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2
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Wong CHM, Ko ICH, Kang SH, Kitamura K, Horie S, Muto S, Ohyama C, Hatakeyama S, Patel M, Yang CK, Kijvikai K, Youl LJ, Chen HG, Zhang RY, Lin TX, Lee LS, Teoh JYC, Chan E. Long-Term Outcomes of Orthotopic Neobladder Versus Ileal Conduit Urinary Diversion in Robot-Assisted Radical Cystectomy (RARC): Multicenter Results from the Asian RARC Consortium. Ann Surg Oncol 2024:10.1245/s10434-024-15396-5. [PMID: 38802711 DOI: 10.1245/s10434-024-15396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Robot-assisted radical cystectomy (RARC) has gained traction in the management of muscle invasive bladder cancer. Urinary diversion for RARC was achieved with orthotopic neobladder and ileal conduit. Evidence on the optimal method of urinary diversion was limited. Long-term outcomes were not reported before. This study was designed to compare the perioperative and oncological outcomes of ileal conduit versus orthotopic neobladder cases of nonmetastatic bladder cancer treated with RARC. PATIENTS AND METHODS The Asian RARC consortium was a multicenter registry involving nine Asian centers. Consecutive patients receiving RARC were included. Cases were divided into the ileal conduit and neobladder groups. Background characteristics, operative details, perioperative outcomes, recurrence information, and survival outcomes were reviewed and compared. Primary outcomes include disease-free and overall survival. Secondary outcomes were perioperative results. Multivariate regression analyses were performed. RESULTS From 2007 to 2020, 521 patients who underwent radical cystectomy were analyzed. Overall, 314 (60.3%) had ileal conduit and 207 (39.7%) had neobladder. The use of neobladder was found to be protective in terms of disease-free survival [Hazard ratio (HR) = 0.870, p = 0.037] and overall survival (HR = 0.670, p = 0.044) compared with ileal conduit. The difference became statistically nonsignificant after being adjusted in multivariate cox-regression analysis. Moreover, neobladder reconstruction was not associated with increased blood loss, nor additional risk of major complications. CONCLUSIONS Orthotopic neobladder urinary diversion is not inferior to ileal conduit in terms of perioperative safety profile and long-term oncological outcomes. Further prospective studies are warranted for further investigation.
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Affiliation(s)
- Chris Ho-Ming Wong
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ivan Ching-Ho Ko
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kousuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University, Hirosaki, Japan
| | | | - Manish Patel
- Department of Urology, The University of Sydney, Sydney, Australia
| | - Cheung-Kuang Yang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kittinut Kijvikai
- Department of Urology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand
| | - Lee Ji Youl
- Department of Urology, Catholic University of Korea, Seoul, Republic of Korea
| | - Hai-Ge Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rui-Yun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tian-Xin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Eddie Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
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3
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Jardot F, Hahn RG, Engel D, Beilstein CM, Wuethrich PY. Blood volume and hemodynamics during treatment of major hemorrhage with Ringer solution, 5% albumin, and 20% albumin: a single-center randomized controlled trial. Crit Care 2024; 28:39. [PMID: 38317178 PMCID: PMC10840277 DOI: 10.1186/s13054-024-04821-6] [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: 11/26/2023] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable option to maintain the blood volume during surgery associated with major hemorrhage. Therefore, the aim of this study was to quantify and compare the plasma volume expansion properties of 5% albumin, 20% albumin, and Ringer-lactate, when infused during major surgery. METHODS In this single-center randomized controlled trial, fluid replacement therapy to combat hypovolemia during the hemorrhagic phase of cystectomy was randomly allocated in 42 patients to receive either 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 min at the beginning of the hemorrhagic phase, both completed by a Ringer-lactate replacing blood loss in a 1:1 ratio, or Ringer-lactate alone to replace blood loss in a 3:1 ratio. Measurements of blood hemoglobin over 5 h were used to estimate the effectiveness of each fluid to expand the blood volume using the following regression equation: blood loss plus blood volume expansion = factor + volume of infused albumin + volume of infused Ringer-lactate. RESULTS The median hemorrhage was 848 mL [IQR: 615-1145]. The regression equation showed that the Ringer-lactate solution expanded the plasma volume by 0.18 times the infused volume while the corresponding power of 5% and 20% albumin was 0.74 and 2.09, respectively. The Ringer-lactate only fluid program resulted in slight hypovolemia (mean, - 313 mL). The 5% and 20% albumin programs were more effective in filling the vascular system; this was evidenced by blood volume changes of only + 63 mL and - 44 mL, respectively, by long-lasting plasma volume expansion with median half time of 5.5 h and 4.8 h, respectively, and by an increase in the central venous pressure. CONCLUSION The power to expand the plasma volume was 4 and almost 12 times greater for 5% albumin and 20% albumin than for Ringer-lactate, and the effect was sustained over 5 h. The clinical efficacy of albumin during major hemorrhage was quite similar to previous studies with no hemorrhage. TRIAL REGISTRATION ClinicalTrials.gov NCT05391607, date of registration May 26, 2022.
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Affiliation(s)
- François Jardot
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Robert G Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Volin J, Daniel J, Walter B, Herndon P, Tran D, Blumline J, Spillinger A, Karabon P, Fletcher C, Folbe A, Hafron J. Cost-effectiveness of routine type and screens in select urological surgeries. Int Urol Nephrol 2023; 55:823-833. [PMID: 36609935 DOI: 10.1007/s11255-022-03452-6] [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: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of obtaining a preoperative type and screen (T/S) for common urologic procedures. METHODS A decision tree model was constructed to track surgical patients undergoing two preoperative blood ordering strategies as follows: obtaining a preoperative T/S versus not doing so. The model was applied to the National (Nationwide) Inpatient Sample (NIS) data, from January 1, 2006 to September 30, 2015. Cost estimates for the model were created from combined patient-level data with published costs of a T/S, type and crossmatch (T/C), a unit of pRBC, and one unit of emergency-release transfusion (ERT). The primary outcome was the incremental cost per ERT prevented, expressed as an incremental cost-effectiveness ratio (ICER) between the two preoperative blood ordering strategies. A cost-effectiveness analysis determined the ICER of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.00. RESULTS A total of 4,113,144 surgical admissions from 2006 to 2015 were reviewed. The overall transfusion rate was 10.54% (95% CI, 10.17-10.91) for all procedures. The ICER of preoperative T/S was $1500.00 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S. CONCLUSION Routine preoperative T/S for radical prostatectomy (rate = 3.88%) and penile implants (rate = .91%) does not represent a cost-effective practice for these surgeries. It is important for urologists to review their institution T/S policy to reduce inefficiencies within the preoperative setting.
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Affiliation(s)
- Joshua Volin
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Joshua Daniel
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Brianna Walter
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA.
| | - Patrick Herndon
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Deanna Tran
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - James Blumline
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Aviv Spillinger
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Craig Fletcher
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Adam Folbe
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Jason Hafron
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
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5
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Dahmen AS, Phuoc VH, Cohen JB, Sexton WJ, Patel SY. Bloodless surgery in urologic oncology: A review of hematologic, anesthetic, and surgical considerations. Urol Oncol 2022; 41:192-203. [PMID: 36470804 DOI: 10.1016/j.urolonc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
The urologic oncology patient who refuses blood transfusion can present unique challenges in perioperative blood management. Since blood loss and associated transfusion can be expected in many complex urologic oncology surgeries, a multidisciplinary approach may be required for optimal outcomes. Through collaboration with the hematologist, anesthesiologist, and urologist, various techniques can be employed in the perioperative phases to minimize blood loss and the need for transfusion. We review the risks and benefits of these techniques and offer recommendations specific to the urologic oncology patient.
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Affiliation(s)
- Aaron S Dahmen
- Department of Urology, University of Chicago, Chicago, IL
| | - Vania H Phuoc
- Department of Medical Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jonathan B Cohen
- Department of Anesthesiology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Sephalie Y Patel
- Department of Anesthesiology, Moffitt Cancer Center and Research Institute, Tampa, FL.
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6
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Preoperative anemia is associated with increased radical cystectomy complications. Urol Oncol 2022; 40:382.e7-382.e13. [DOI: 10.1016/j.urolonc.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
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ERGENOĞLU P, ERSOY Z, ARIBOGAN A. Mesane kanserinde radikal sistektomi üriner diversiyon operasyonu yapılan hastalarda perioperatif parametrelerin değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1053426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose: The aim of this study was to evaluate the effect of red blood cell transfusion and/or inotropic/vasopressor agent infusion during intraoperative and postoperative first 24-hour period on 30-day and one-year survival.
Materials and Methods: In the final analysis, 133 patients who underwent radical cystectomy and urinary diversion surgery between November 2011 and January 2019 were included in this study. Perioperative anesthesia management early postoperative intensive care patient follow-ups were based on.
Results: A statistically significant relationship was found between intraoperative red blood cell transfusion and one-year mortality rates. A statistically significant relationship was found between red blood cell transfusion in the intensive care unit and postoperative 30-day mortality rates. The relationship between vasopressor/inotrope agent infusion in intensive care unit and postoperative 30-day mortality was statistically significant.
Conclusion: In radical cystectomy and urinary diversion, intraoperative red blood cell and/or inotrope/vasopressor drug administration, and red blood cell transfusion within first 24 postoperative hours in intensive care unit are associated with lower survival rates in both early and late periods. Future studies should focus on developing and implementing different strategies for perioperative blood management and maintenance of patient hemodynamics that may affect early and late outcomes.
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8
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Teoh JYC, Chan EOT, Kang SH, Patel MI, Muto S, Yang CK, Hatakeyama S, Chow TSF, Mok A, Zhang R, Kijvikai K, Lee LS, Chen H, Ohyama C, Horie S, Chan ESY. Perioperative Outcomes of Robot-Assisted Radical Cystectomy with Intracorporeal Versus Extracorporeal Urinary Diversion. Ann Surg Oncol 2021; 28:9209-9215. [PMID: 34152523 DOI: 10.1245/s10434-021-10295-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to investigate and compare the perioperative outcomes of intracorporeal urinary diversion (ICUD) versus extracorporeal urinary diversion (ECUD) following robotic-assisted radical cystectomy (RARC) in patients with localized bladder cancer from the Asian Robot-Assisted Radical Cystectomy (RARC) Consortium. METHODS The Asian RARC registry was a multicenter registry involving nine centers in Asia. Consecutive patients who underwent RARC were included. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed and compared between the ICUD and ECUD groups. Postoperative complications were the primary outcomes, whereas secondary outcomes were the estimated blood loss and the duration of hospitalization. Multivariate regression analyses were performed to adjust potential confounders. RESULTS From 2007 to 2020, 556 patients underwent RARC; 55.2% and 44.8% had ICUD and ECUD, respectively. ICUD group had less estimated blood loss (423.1 ± 361.1 vs. 541.3 ± 474.3 mL, p = 0.002) and a shorter hospital stay (15.7 ± 12.3 vs 17.8 ± 11.6 days, p = 0.042) than the ECUD group. Overall complication rates were similar between the two groups. Upon multivariate analysis, ICUD was associated with less estimated blood loss (Regression coefficient: - 143.06, 95% confidence interval [CI]: - 229.60 to - 56.52, p = 0.001) and a shorter hospital stay (Regression coefficient: - 2.37, 95% CI: - 4.69 to - 0.05, p = 0.046). In addition, ICUD was not associated with any increased risks of minor, major, and overall complications. CONCLUSIONS RARC with ICUD was safe and technically feasible with similar postoperative complication rates as ECUD, with additional benefits of reduced blood loss and a shorter hospitalization.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,European Association of Urology Young Academic Urologists, Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands.
| | - Erica On-Ting Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Seok-Ho Kang
- Department of Urology, School of Medicine, Korea University, Seoul, Republic of Korea
| | - Manish I Patel
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Satoru Muto
- Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Timothy Shing-Fung Chow
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Mok
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruiyun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lui-Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore.,Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeo Horie
- Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
| | - Eddie Shu-Yin Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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9
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Tan WS, Wang Y, Trinh QD, Preston MA, Kelly JD, Hrouda D, Kibel AS, Krasnow RE, Liu JJ, Chung BI, Chang SL, Mossanen M. Delayed blood transfusion is associated with mortality following radical cystectomy. Scand J Urol 2020; 54:290-296. [DOI: 10.1080/21681805.2020.1777195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Wei Shen Tan
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Northwick Park Hospital, London, UK
| | - Ye Wang
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mark A. Preston
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John D. Kelly
- Division of Surgery & Interventional Science, University College London, London, UK
| | - David Hrouda
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ross E. Krasnow
- Department of Urology, Med Star Washington Hospital Center, Washington, DC, USA
| | - Jen-Jane Liu
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin I. Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Steven L. Chang
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew Mossanen
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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10
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Myrga JM, Ayyash OM, Bandari J, Fam MM, Macleod LC, Jacobs BL, Davies BJ. The Safety and Short-term Outcomes of Leukocyte Depleted Autologous Transfusions During Radical Cystectomy. Urology 2019; 135:106-110. [PMID: 31626857 DOI: 10.1016/j.urology.2019.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine long- and short-term outcomes using cell salvage with a commercially available leukocyte depletion filter following radical cystectomy in an oncologic population. MATERIALS AND METHODS One hundred and fifty-seven patients, 87 of whom received a cell salvage transfusion, were retrospectively identified from chart review. Ninety-day outcomes as well as long-term mortality and cancer recurrence data were collected. Chi-square, Student's t, or Mann-Whitney U tests were used as appropriate. Multivariable regressions of survival were performed with a Cox proportional-hazards model. RESULTS Those who received a cell salvage transfusion did not show any differences in rate of cancer recurrence (23%) vs those who did not receive a cell salvage transfusion (24%; P = .85). There were also no differences noted in mortality rates between the 2 populations (12% vs 17%; P = .36). Furthermore, no differences were noted in postoperative complication rates, length of hospital stay, 90-day culture positive infections or readmissions (P >.05). CONCLUSION There are no significant differences in short-term or long-term patient outcomes between those who did and did not receive an intraoperative cell salvage transfusion. Cell salvage transfusions with a leukocyte depletion filter are safe and effective methods to reduce the need for allogeneic blood transfusions while controlling for the theoretical risk of metastatic spread.
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Affiliation(s)
- John M Myrga
- University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA.
| | - Omar M Ayyash
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Jathin Bandari
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Mina M Fam
- Jersey Shore University Medical Center, Monmouth, NJ
| | | | - Bruce L Jacobs
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
| | - Benjamin J Davies
- University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, PA
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11
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Abu-Ghanem Y, Ramon J. Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies. Ther Adv Urol 2019; 11:1756287219868054. [PMID: 31447936 PMCID: PMC6691668 DOI: 10.1177/1756287219868054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Centre, Tel-Hashomer, Ramat-Gan, 52621, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Centre, Ramat-Gan, Israel
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Ceanga AI, Ceanga M, Eveslage M, Herrmann E, Fischer D, Haferkamp A, Wittmann M, Müller S, Van Aken H, Steinbicker AU. Preoperative anemia and extensive transfusion during stay-in-hospital are critical for patient`s mortality: A retrospective multicenter cohort study of oncological patients undergoing radical cystectomy. Transfus Apher Sci 2018; 57:739-745. [PMID: 30301602 DOI: 10.1016/j.transci.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Preoperative anemia and allogeneic blood transfusions (ABTs) may affect outcomes in cancer surgery. The prevalence of anemia, the use of ABTs, the risks of transfusions, lengths of stay and mortality of oncological patients undergoing radical cystectomy were investigated in three University Hospitals in Germany. PATIENTS AND METHODS Hospital records of 220 consecutive patients undergoing radical cystectomy from 2010 to 2012 were retrospectively analyzed for independent risk factors of ABT and unfavorable outcomes (readmission, increased length of stay (LOS) or death) using multivariate regression analysis. RESULTS Preoperative anemia was present in 40%. 70% of patients received blood transfusions. Low preoperative and intraoperative nadir hemoglobin levels were associated with receipt of ABT (OR 1.33, P = 0.04 and OR 2.94, P < 0.001 respectively). Transfusion of ten or more red blood cell units (RBCs) during the entire hospital stay was a predictor of an increased LOS (P < 0.001) and death (OR 52, 95%CI [5.9, 461.3], P < 0.001), compared to non-transfused patients. Preoperative ABT and ASA scores were associated with ≥10RBCs. CONCLUSION Anemic patients undergoing radical cystectomy had a high risk to receive ABTs. Preoperative transfusions and transfusion of ≥10RBCs during the entire hospital stay may increase patient`s mortality. Prospective, randomized controlled studies have to follow this study.
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Affiliation(s)
- Andreea-Iuliana Ceanga
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Mihai Ceanga
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Dania Fischer
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Axel Haferkamp
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Maria Wittmann
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefan Müller
- Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Hugo Van Aken
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Andrea Ulrike Steinbicker
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.
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Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission. J Robot Surg 2018; 13:129-140. [PMID: 29948875 DOI: 10.1007/s11701-018-0832-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/03/2018] [Indexed: 12/29/2022]
Abstract
The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien-Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20-0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.
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Breau RH, Lavallée LT, Cnossen S, Witiuk K, Cagiannos I, Momoli F, Bryson G, Kanji S, Morash C, Turgeon A, Zarychanski R, Mallick R, Knoll G, Fergusson DA. Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized Controlled Trial. Trials 2018; 19:261. [PMID: 29716640 PMCID: PMC5930484 DOI: 10.1186/s13063-018-2626-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radical cystectomy for bladder cancer is associated with a high risk of needing red blood cell transfusion. Tranexamic acid reduces blood loss during cardiac and orthopedic surgery, but no study has yet evaluated tranexamic acid use during cystectomy. METHODS A randomized, double-blind (surgeon-, anesthesiologist-, patient-, data-monitor-blinded), placebo-controlled trial of tranexamic acid during cystectomy was initiated in June 2013. Prior to incision, the intervention arm participants receive a 10 mg/kg loading dose of intravenously administered tranexamic acid, followed by a 5 mg/kg/h maintenance infusion. In the control arm, the patient receives an identical volume of normal saline that is indistinguishable from the intervention. The primary outcome is any blood transfusion from the start of surgery up to 30 days post operative. There are no strict criteria to mandate the transfusion of blood products. The decision to transfuse is entirely at the discretion of the treating physicians who are blinded to patient allocation. Physicians are allowed to utilize all resources to make transfusion decisions, including serum hemoglobin concentration and vital signs. To date, 147 patients of a planned 354 have been randomized to the study. DISCUSSION This protocol reviews pertinent data relating to blood transfusion during radical cystectomy, highlighting the need to identify methods for reducing blood loss and preventing transfusion in patients receiving radical cystectomy. It explains the clinical rationale for using tranexamic acid to reduce blood loss during cystectomy, and outlines the study methods of our ongoing randomized controlled trial. TRIAL REGISTRATIONS Canadian Institute for Health Research (CIHR) Protocol: MOP-342559; ClinicalTrials.gov, ID: NCT01869413. Registered on 5 June 2013.
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Affiliation(s)
- Rodney H Breau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gregory Bryson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, ON, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexis Turgeon
- CHU de Québec, Université Laval, Québec City, QC, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Greg Knoll
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Syan-Bhanvadia S, Drangsholt S, Shah S, Cai J, Miranda G, Djaladat H, Daneshmand S. Restrictive transfusion in radical cystectomy is safe. Urol Oncol 2017; 35:528.e15-528.e21. [DOI: 10.1016/j.urolonc.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 11/16/2022]
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16
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Is Experience a Surrogate for Expertise? Anesth Analg 2017. [DOI: 10.1213/ane.0000000000001895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Cui HW, Turney BW, Griffiths J. The Preoperative Assessment and Optimization of Patients Undergoing Major Urological Surgery. Curr Urol Rep 2017; 18:54. [PMID: 28589402 PMCID: PMC5486597 DOI: 10.1007/s11934-017-0701-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Improving patient outcomes from major urological surgery requires not only advancement in surgical technique and technology, but also the practice of patient-centered, multidisciplinary, and integrated medical care of these patients from the moment of contemplation of surgery until full recovery. This review examines the evidence for recent developments in preoperative assessment and optimization that is of relevance to major urological surgery. RECENT FINDINGS Current perioperative medicine recommendations aim to improve the short-term safety and long-term effectiveness of surgical treatments by the delivery of multidisciplinary integrated medical care. New strategies to deliver this aim include preoperative risk stratification using a frailty index and cardiopulmonary exercise testing for patients undergoing intra-abdominal surgery (including radical cystectomy), preoperative management of iron deficiency and anemia, and preoperative exercise intervention. Proof of the utility and validity for improving surgical outcomes through advances in preoperative care is still evolving. Evidence-based developments in this field are likely to benefit patients undergoing major urological surgery, but further research targeted at high-risk patients undergoing specific urological operations is required.
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Affiliation(s)
- Helen W. Cui
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK
| | - Benjamin W. Turney
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK
| | - John Griffiths
- Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU UK
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Sui W, Onyeji IC, Matulay JT, James MB, Theofanides MC, Wenske S, DeCastro GJ. Perioperative blood transfusion in radical cystectomy: Analysis of the National Surgical Quality Improvement Program database. Int J Urol 2016; 23:745-50. [PMID: 27399354 DOI: 10.1111/iju.13152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether perioperative blood transfusion is associated with worse 30-day postoperative outcomes in radical cystectomy patients. METHODS Utilizing the National Surgical Quality Improvement Program database, we identified 2934 patients diagnosed with bladder cancer (International Classification of Diseases Ninth Revision codes 188-188.9) who underwent radical cystectomy (Current Procedure Terminology codes 51570, 51575, 51580, 51585, 51590, 51595, 51596) between 2005 and 2013. Patients were stratified by transfusion status and assessed based on four composite postoperative outcomes: morbidity, surgical site infection, mortality and readmission. Multivariate regression models were used to determine significant independent predictors of the composite outcomes. RESULTS Overall, 40.1% of patients received a transfusion, and there were significant differences in baseline variables such as age, sex, body mass index, smoking history and comorbidities. Transfusion was associated with increased morbidity, surgical site infection, readmission, operative time and length of stay on unadjusted analyses. On multivariate regression, transfusion was associated with increased morbidity (OR 1.361, 95% CI 1.131-1.638) and surgical site infection (OR 1.371, 95% CI 1.070-1.757). CONCLUSIONS Perioperative blood transfusion is associated with increased risk of postoperative infection and morbidity. Previous work in this area has focused on negative long-term oncological outcomes, but this is the first study to examine short-term postoperative outcomes. Future research should focus on the immunosuppressive mechanism of perioperative blood transfusion and on restrictive transfusion guidelines for oncology patients.
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Affiliation(s)
- Wilson Sui
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ifeanyi C Onyeji
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Justin T Matulay
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Maxwell B James
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marissa C Theofanides
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sven Wenske
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Guarionex J DeCastro
- Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
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Chang SS. Re: Intraoperative Continuous Norepinephrine Infusion Combined with Restrictive Deferred Hydration Significantly Reduces the Need for Blood Transfusion in Patients Undergoing Open Radical Cystectomy: Results of a Prospective Randomised Trial. J Urol 2016; 195:902-3. [PMID: 27302775 DOI: 10.1016/j.juro.2016.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 11/19/2022]
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20
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Kong YG, Kim JY, Yu J, Lim J, Hwang JH, Kim YK. Efficacy and Safety of Stroke Volume Variation-Guided Fluid Therapy for Reducing Blood Loss and Transfusion Requirements During Radical Cystectomy: A Randomized Clinical Trial. Medicine (Baltimore) 2016; 95:e3685. [PMID: 27175706 PMCID: PMC4902548 DOI: 10.1097/md.0000000000003685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Radical cystectomy, which is performed to treat muscle-invasive bladder tumors, is among the most difficult urological surgical procedures and puts patients at risk of intraoperative blood loss and transfusion. Fluid management via stroke volume variation (SVV) is associated with reduced intraoperative blood loss. Therefore, we evaluated the efficacy and safety of SVV-guided fluid therapy for reducing blood loss and transfusion requirements in patients undergoing radical cystectomy.This study included 48 patients who underwent radical cystectomy, and these patients were randomly allocated to the control group and maintained at <10% SVV (n = 24) or allocated to the trial group and maintained at 10% to 20% SVV (n = 24). The primary endpoints were comparisons of the amounts of intraoperative blood loss and transfused red blood cells (RBCs) between the control and trial groups during radical cystectomy. Intraoperative blood loss was evaluated through the estimated blood loss and estimated red cell mass loss. The secondary endpoints were comparisons of the postoperative outcomes between groups.A total of 46 patients were included in the final analysis: 23 patients in the control group and 23 patients in the trial group. The SVV values in the trial group were significantly higher than in the control group. Estimated blood loss, estimated red cell mass loss, and RBC transfusion requirements in the trial group were significantly lower than in the control group (734.3 ± 321.5 mL vs 1096.5 ± 623.9 mL, P = 0.019; 274.1 ± 207.8 mL vs 553.1 ± 298.7 mL, P <0.001; 0.5 ± 0.8 units vs 1.9 ± 2.2 units, P = 0.005). There were no significant differences in postoperative outcomes between the two groups.SVV-guided fluid therapy (SVV maintained at 10%-20%) can reduce blood loss and transfusion requirements in patients undergoing radical cystectomy without resulting in adverse outcomes. These findings provide useful information for optimal fluid management during radical cystectomy.
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Affiliation(s)
- Yu-Gyeong Kong
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Bauman TM, Vezina CM, Ricke EA, Halberg RB, Huang W, Peterson RE, Ricke WA. Expression and colocalization of β-catenin and lymphoid enhancing factor-1 in prostate cancer progression. Hum Pathol 2016; 51:124-33. [PMID: 27067790 DOI: 10.1016/j.humpath.2015.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to objectively investigate β-catenin and LEF1 abundance, subcellular localization, and colocalization across benign and staged prostate cancer (PCa) specimens. A tissue microarray containing tumor-adjacent histologically benign prostate tissue (BPT; n = 48 patients), high-grade prostatic intraepithelial neoplasia (HGPIN; n = 25), localized PCa (n = 42), aggressive PCa (n = 31), and metastases (n = 22) was stained using multiplexed immunohistochemistry with antibodies toward E-cadherin, β-catenin, and LEF1. Multispectral imaging was used for quantitation, and protein expression and colocalization was evaluated across PCa progression. Stromal nuclear β-catenin abundance was greater in HGPIN and PCa compared with BPT (P < .05 for both), and epithelial nuclear β-catenin abundance was lower in metastatic PCa than in BPT (P < .05 for both). Epithelial and stromal nuclear LEF1 abundance was greater in HGPIN compared with BPT, whereas epithelial nuclear LEF1 was also greater in metastases. The proportion of epithelial and stromal nuclear double-positive β-catenin(+)/LEF1(+) cells was greater in HGPIN compared with BPT. In addition, the proportion of epithelial β-catenin(+)/LEF1(+) cells was greater in localized PCa and metastases compared with BPT. A significant amount of stromal cells were positive for LEF1 but not β-catenin. β-Catenin and LEF1 abundance were negatively correlated in the epithelium (P < .0001) but not the stroma (P > .05). We conclude that β-catenin and LEF1 colocalization is increased in HGPIN and metastasis relative to BPT, suggesting a role for β-catenin/LEF1-mediated transcription in both malignant transformation and metastasis of PCa. Furthermore, our results suggest that LEF1 abundance alone is not a reliable readout for β-catenin activity in prostate tissues.
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Affiliation(s)
- Tyler M Bauman
- Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO 53705
| | - Chad M Vezina
- Department of Comparative Biosciences, University of Wisconsin School of Veterinary Medicine, Madison, WI 53705; University of Wisconsin O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Emily A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Richard B Halberg
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Wei Huang
- University of Wisconsin O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705; Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Richard E Peterson
- Division of Pharmaceutical Sciences, University of Wisconsin School of Pharmacy, Madison, WI 53705
| | - William A Ricke
- University of Wisconsin O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705.
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The Impact of Pelvic Venous Pressure on Blood Loss during Open Radical Cystectomy and Urinary Diversion: Results of a Secondary Analysis of a Randomized Clinical Trial. J Urol 2015; 194:146-52. [DOI: 10.1016/j.juro.2014.12.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/23/2022]
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Wang YL, Jiang B, Yin FF, Shi HQ, Xu XD, Zheng SS, Wu S, Hou SC. Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0130122. [PMID: 26080092 PMCID: PMC4469696 DOI: 10.1371/journal.pone.0130122] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/18/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Multiple studies have investigated the effect of perioperative blood transfusion (PBT) for patients with radical cystectomy (RC), but the results have been inconsistent. We conducted a systematic review and meta-analysis to investigate the relationship between PBT and the clinical outcomes of RC patients. METHODS We searched MEDLINE, EMBASE, the Cochrane library and BIOSIS previews to identify relevant literature for studies that focused on the relationship of PBT and outcomes of patients undergoing RC. A fixed or random effects model was used in this meta-analysis to calculate the pooled hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS A total of 7080 patients in 6 studies matched the selection criteria. Aggregation of the data suggested that PBT in patients who underwent RC correlated with increased all-cause mortality, cancer-specific mortality and cancer recurrence. The combined HRs were 1.19 (n = 6 studies, 95% CI: 1.11-1.27, Z = 4.71, P<0.00001), 1.17 (n = 4 studies, 95% CI: 1.06-1.30, Z = 3.06, P = 0.002), 1.14 (n = 3 studies, 95% CI: 1.03-1.27, Z = 2.50, P = 0.01), respectively. The all-cause mortality associated with PBT did not vary by the characteristics of the study, including number of study participants, follow-up period and the median blood transfusion ratio of the study. CONCLUSION Our data showed that PBT significantly increased the risks of all-cause mortality, cancer-specific mortality and cancer recurrence in patients undergoing RC for bladder cancer.
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Affiliation(s)
- You-Lin Wang
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Bo Jiang
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Fu-Fen Yin
- Department of Obstetrics and Gynecology, Affiliate Hospital of Qingdao University, Qingdao, China
| | - Hao-Qing Shi
- Department of Urology, Affiliate Hospital of Qingdao University, Qingdao, China
| | - Xiao-Dong Xu
- Department of Urology, Affiliate Hospital of Qingdao University, Qingdao, China
| | - Shuai-Shuai Zheng
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Shuai Wu
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Si-Chuan Hou
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
- Department of Urology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
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Preoperative anemia is associated with adverse outcome in patients with urothelial carcinoma of the bladder following radical cystectomy. J Cancer Res Clin Oncol 2015; 141:1819-26. [PMID: 25832016 DOI: 10.1007/s00432-015-1957-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Radical cystectomy (RC) can be associated with significant blood loss, whereas many patients are presenting with anemia preoperatively. To date, there is a lack of data addressing the impact of preoperative anemia (PA) on survival of patients undergoing RC for urothelial carcinoma of the bladder (UCB). METHODS This retrospective multicenter study includes 684 patients with UCB undergoing RC with pelvic lymph node dissection. The median follow-up was 50 (IQR 29,78) months. Anemia was defined in line with the WHO classification (hemoglobin (Hb): male ≤13 g/dL, female ≤12 g/dL) and based on contemporary gender- and age-adjusted classification (Hb: white male aged <60 years: ≤13.7 g/dL; ≥60 years: ≤13.2 g/dL; white female of all ages ≤12.2 g/dL). Univariable and multivariable Cox regression analyses were used to assess the effects of PA on oncological outcomes. RESULTS A total of 269 (39.3 %) and 302 (44.2 %) patients were anemic according to the WHO classification versus contemporary classification. Age, increased ECOG performance status, advanced tumor stages, lymph node metastasis, positive surgical margin and anemia were associated with disease recurrence (DR), cancer-specific mortality (CSM) and all-cause mortality (ACM). In multivariable analysis, anemia was an independent predictor of DR, CSM and ACM (WHO and/or contemporary classification). Blood transfusion was significantly associated with ACM in both classifications of anemia. CONCLUSIONS PA is significantly associated with worse oncological outcome in patients undergoing RC. Based on the additional unfavorable influence of blood transfusion, this emphasizes the importance of early diagnosis and correction of anemia and implementation of alternative methods of blood volume management.
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Zakaria AS, Santos F, Tanguay S, Kassouf W, Aprikian AG. Radical cystectomy in patients over 80 years old in Quebec: A population-based study of outcomes. J Surg Oncol 2015; 111:917-22. [PMID: 25663440 DOI: 10.1002/jso.23887] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/27/2014] [Accepted: 12/29/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To document radical cystectomy (RC) outcomes in patients over 80 years old across Quebec during the years 2000-2009 and to examine potentially related factors. METHODS Within Quebec health insurance medical services database, we identified patients over 80 years who underwent RC. The outcomes analyzed were post-operative complications, mortality rates at 30, 60 and 90 days and overall survival. RESULTS A total of 275 patients over 80 years old had RC performed in 38 hospitals across Quebec. Among them, 33% had major post-operative complications with 16% having more than one complication. Mortality rates at 30, 60 and 90 days were 5.8%, 9.8% and 13% respectively. 44.3% of RCs were performed in seven academic hospitals with mortality rates of 2.5%, 6.5% and 9% respectively. Community hospitals had mortality of 8.5%, 12.4% and 16.3% respectively (P < 0.001). The cohort 5-year overall survival rate was 27%. The presence of post-operative complications and the number of complications negatively affected overall survival (P < 0.001) CONCLUSION: Patients over 80 years of age have high post-RC mortality rates, especially at 90 days. In addition, it appears that they have lower post-operative mortality if their RCs were performed in academic centers. Mortality rates and complications can be used when obtaining informed consent.
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Affiliation(s)
- Ahmed S Zakaria
- Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada
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Breau RH, Kokolo MB, Punjani N, Cagiannos I, Beck A, Niznick N, Buenaventura C, Cowan J, Knoll G, Momoli F, Morash C, Ruzicka M, Schachkina S, Tinmouth A, Xie HY, Fergusson DA. The Effects of Lysine Analogs During Pelvic Surgery: A Systematic Review and Meta-Analysis. Transfus Med Rev 2014; 28:145-55. [DOI: 10.1016/j.tmrv.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 04/29/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
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Tang K, Li H, Xia D, Hu Z, Zhuang Q, Liu J, Xu H, Ye Z. Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies. PLoS One 2014; 9:e95667. [PMID: 24835573 PMCID: PMC4023936 DOI: 10.1371/journal.pone.0095667] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/29/2014] [Indexed: 12/03/2022] Open
Abstract
Background and Objective More recently laparoscopic radical cystectomy (LRC) has increasingly been an attractive alternative to open radical cystectomy (ORC) and many centers have reported their early experiences in the treatment of bladder cancer. Evaluate the safety and efficacy of LRC compared with ORC in the treatment of bladder cancer. Methods A systematic search of Medline, Scopus, and the Cochrane Library was performed up to Mar 1, 2013. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative, pathologic and oncological variables, and post-op neobladder function and complications. Results Sixteen eligible trials evaluating LRC vs ORC were identified including seven prospective and nine retrospective studies. Although LRC was associated with longer operative time (p<0.001), patients might benefit from significantly fewer overall complications (p<0.001), less blood loss (p<0.001), shorter length of hospital stay (p<0.001), less need of blood transfusion (p<0.001), less narcotic analgesic requirement (p<0.001), shorter time to ambulation (p = 0.03), shorter time to regular diet (p<0.001), fewer positive surgical margins (p = 0.006), fewer positive lymph node (p = 0.05), lower distant metastasis rate (p = 0.05) and fewer death (p = 0.004). There was no significant difference in other demographic parameters except for a lower ASA score (p = 0.01) in LRC while post-op neobladder function were similar between the two groups. Conclusions Our data suggest that LRC appears to be a safe, feasible and minimally invasive alternative to ORC with reliable perioperative safety, pathologic & oncologic efficacy, comparable post-op neobladder function and fewer complications. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric, long-term follow-up studies and randomized control trials should be undertaken to confirm our findings.
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Affiliation(s)
- Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianyuan Zhuang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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The effect of intra- and postoperative allogenic blood transfusion on patients' survival undergoing radical cystectomy for urothelial carcinoma of the bladder. World J Urol 2014; 32:1447-53. [PMID: 24510120 DOI: 10.1007/s00345-014-1257-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 01/29/2014] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Radical cystectomy (RC) can be associated with significant blood loss. Allogenic blood transfusion (ABT) may alter disease outcome because of a theoretical immunomodulatory effect. We evaluated the effects of ABT on overall survival (OS) and progression-free survival (PFS) of patients undergoing RC for urothelial carcinoma of the bladder (UCB). MATERIALS AND METHODS This is a retrospective single-center study of 350 consecutive patients of a university health center with a median follow-up of 70.1 month. All patients underwent RC and pelvic lymph node dissection. The effect of ABT on OS and PFS was analyzed using univariable and multivariable Cox proportional hazards models. RESULTS The overall ABT rate was 63 % (n = 219), with intraoperative blood transfusion and postoperative blood transfusion being performed in 183 patients (52 %) and 99 patients (28 %), respectively. Preoperative anemia was detected in 156 patients (45 %) with median estimated blood loss of 800 ml (IQR: 500-1,200). ABT was associated with significant decrease of OS and PFS in multivariable analyses (p < 0.001), whereas patients' prognosis worsened the more packed red blood cells (PRBC) were transfused (p < 0.001). The study is limited in part due to its retrospective design. CONCLUSIONS We found that ABT and the number of PRBC transfused are associated with poor prognosis for UCB patients undergoing RC, whereas preoperative anemia had no influence on survival. This emphasizes the importance of surgeon's awareness for a strict indication for ABT. A prospective study will be necessary to evaluate the independent risks associated with ABT during surgical treatments.
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A prospective randomised controlled trial of laparoscopic vs open radical cystectomy for bladder cancer: perioperative and oncologic outcomes with 5-year follow-upT Lin et al. Br J Cancer 2014; 110:842-9. [PMID: 24407192 PMCID: PMC3929868 DOI: 10.1038/bjc.2013.777] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 12/20/2022] Open
Abstract
Background: Laparoscopic radical cystectomy (LRC) is increasingly being used for muscle-invasive bladder cancer. However, high levels of clinical evidence comparing laparoscopic vs open radical cystectomy (ORC) are lacking. Methods: A prospective randomised controlled clinical trial comparing LRC vs ORC in patients undergoing radical cystectomy for bladder cancer. Thirty-five patients were eligible for final analysis in each group. Results: The median follow-up was 26 months (range, 4–59 months) for laparoscopic vs 32 months (range, 6–60 months) for ORC. Significant differences were noted in operative time, estimated blood loss (EBL), blood transfusion rate, analgesic requirement, and time to resumption of oral intake. No significant differences were noted in the length of hospital stay, complication rate, lymph node yield (14.1±6.3 for LRC and 15.2±5.9 for ORC), positive surgical margin rate, postoperative pathology, or recurrence rate (7 for LRC and 8 for ORC). The 5-year recurrence-free survival with laparoscopic vs ORC was 78.5% vs 70.9%, respectively (P=0.773). The overall survival with laparoscopic vs ORC was 73.8% vs 67.4%, respectively (P=0.511). Conclusion: Our study demonstrated that LRC is superior to ORC in perioperative outcomes, including EBL, blood transfusion rate, and analgesic requirement. We found no major difference in oncologic outcomes. The number of patients is too small to allow for a final conclusion.
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Thompson IM, Kappa SF, Morgan TM, Barocas DA, Bischoff CJ, Keegan KA, Stratton KL, Clark PE, Resnick MJ, Smith JA, Cookson MS, Chang SS. Blood loss associated with radical cystectomy: a prospective, randomized study comparing Impact LigaSure vs. stapling device. Urol Oncol 2013; 32:45.e11-5. [PMID: 24054870 DOI: 10.1016/j.urolonc.2013.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/09/2013] [Accepted: 06/11/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Radical cystectomy (RC) is associated with significant blood loss and transfusion requirement. We performed a prospective, randomized trial to compare blood loss, operative time, and cost using 2 different and commonly employed approaches to tissue ligation and division during RC: mechanical (stapler device) and electrosurgical (heat-sealing device). METHODS AND MATERIALS Eighty patients undergoing RC for urothelial bladder carcinoma were randomized to use of either an Endo GIA Stapler or Impact LigaSure device for tissue ligation and division. Primary outcomes were blood loss, operative time, and device costs. Data were analyzed with Wilcoxon rank sum test and Welch 2-sample t test. RESULTS There were no significant demographic or preoperative differences between the cohorts. Mean estimated blood loss was similar between the electrosurgical (687 ml) and stapler (708 ml) arms (P = 0.850). There were no significant differences between cohorts when comparing operative times or transfusion requirement. There was a significant increase in the mean number of adjunctive suture ligatures used in the stapling device arm (3.0 vs. 1.5, P = 0.047). Total device costs were significantly lower with the LigaSure compared with the GIA Stapler ($625.00 vs. $1490.10, P<0.001). There were no complications attributable to either device. CONCLUSIONS This prospective, randomized study demonstrates no significant difference in blood loss, transfusion requirement, or safety between mechanical vs. electrosurgical control of the vascular pedicles. The LigaSure device, however, is significantly less costly than the GIA Stapler and required fewer additional measures for hemostasis.
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Affiliation(s)
- Ian M Thompson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen F Kappa
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Todd M Morgan
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Carl J Bischoff
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kirk A Keegan
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kelly L Stratton
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Peter E Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph A Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S Cookson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Abstract
INTRODUCTION Preoperative estimation of intra-operative blood loss by both anaesthetist and operating surgeon is a criterion of the World Health Organization's surgical safety checklist. The checklist requires specific preoperative planning when anticipated blood loss is greater than 500 mL. The aim of this study was to assess the accuracy of surgeons and anaesthetists at predicting intra-operative blood loss. METHODS A 6-week prospective study of intermediate and major operations in an academic medical centre was performed. An independent observer interviewed surgical and anaesthetic consultants and registrars, preoperatively asking each to predict expected blood loss in millilitre. Intra-operative blood loss was measured and compared with these predictions. Parameters including the use of anticoagulation and anti-platelet therapy as well as intra-operative hypothermia and hypotension were recorded. RESULTS One hundred sixty-eight operations were included in the study, including 142 elective and 26 emergency operations. Blood loss was predicted to within 500 mL of measured blood loss in 89% of cases. Consultant surgeons tended to underestimate blood loss, doing so in 43% of all cases, while consultant anaesthetists were more likely to overestimate (60% of all operations). Twelve patients (7%) had underestimation of blood loss of more than 500 mL by both surgeon and anaesthetist. Thirty per cent (n = 6/20) of patients requiring transfusion of a blood product within 24 hours of surgery had blood loss underestimated by more than 500 mL by both surgeon and anaesthetist. There was no significant difference in prediction between patients on anti-platelet or anticoagulation therapy preoperatively and those not on the said therapies. CONCLUSION Predicted intra-operative blood loss was within 500 mL of measured blood loss in 89% of operations. In 30% of patients who ultimately receive a blood transfusion, both the surgeon and anaesthetist significantly underestimate the risk of blood loss by greater than 500 mL. Theatre staff must be aware that 1 in 14 patients undergoing intermediate or major surgery will have an unexpected blood loss exceeding 500 mL and so robust policies to identify and manage such circumstances should be in place to improve patient safety.
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The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol 2013; 63:839-45. [PMID: 23332883 DOI: 10.1016/j.eururo.2013.01.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/06/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND While the receipt of a perioperative blood transfusion (PBT) has been associated with an increased risk of mortality for a number of malignancies, the relationship between PBT and survival following radical cystectomy (RC) for bladder cancer (BCa) has not been well established. OBJECTIVE To evaluate the association of PBT with disease recurrence and mortality following RC. DESIGN, SETTING, AND PARTICIPANTS We identified 2060 patients who underwent RC at the Mayo Clinic between 1980 and 2005. PBT was defined as transfusion of allogenic red blood cells during RC or postoperative hospitalization. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Survival was estimated using the Kaplan-Meier method and was compared with the log-rank test. Cox proportional hazard regression models were used to evaluate the association of PBT with outcome, controlling for clinicopathologic variables. RESULTS AND LIMITATIONS A total of 1279 patients (62%) received PBT. The median number of units transfused was 2 (interquartile range [IQR]: 2-4). Patients receiving PBT were significantly older (median: 69 yr vs 66 yr; p<0.0001), had a worse Eastern Cooperative Oncology Group performance status (p<0.0001), and were more likely to have muscle-invasive tumors (56% vs 49%; p = 0.004). Median postoperative follow-up was 10.9 yr (IQR: 7.9-15.7). Receipt of PBT was associated with significantly worse 5-yr recurrence-free survival (58% vs 64%; p = 0.01), cancer-specific survival (59% vs 72%; p<0.001), and overall survival (45% vs 63%; p<0.001). On multivariate analyses, PBT remained associated with significantly increased risks of postoperative tumor recurrence (hazard ratio [HR]: 1.20; p = 0.04), death from BCa (HR: 1.31; p = 0.003), and all-cause mortality (HR: 1.27; p = 0.0002). Among patients who received PBT, an increasing number of units transfused was independently associated with increased cancer-specific mortality (HR: 1.07; p<0.0001) and all-cause mortality (HR: 1.05; p<0.0001). Limitations include selection bias and lack of standardized transfusion criteria. CONCLUSIONS We found that PBT is associated with significantly increased risks of cancer recurrence and mortality following RC. While external validation is required, continued efforts to reduce the use of blood products in these patients are warranted.
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Khan MS, Challacombe B, Elhage O, Rimington P, Coker B, Murphy D, Grieve A, Dasgupta P. A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy. Int J Clin Pract 2012; 66:656-62. [PMID: 22507234 DOI: 10.1111/j.1742-1241.2011.02888.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The role of minimally invasive radical cystectomy as opposed to open surgery for bladder cancer is not yet established. We present comparative outcomes of open, laparoscopic and robotic-assisted radical cystectomy MATERIAL AND METHODS Prospective cohort comparison of 158 patients from 2003-2008 undergoing open radical cystectomy (ORC) (n = 52), laparoscopic radical cystectomy (LRC) (n =58) or robotic-assisted radical cystectomy (RARC) (n = 48) performed by a team of three surgeons at two hospitals. Peri-operative data, complication rates, length of hospital stay, oncological outcome (including lymph node status) and survival were recorded. Statistical analyses were adjusted to account for potential confounding factors such as ASA grade, gender, age, diversion type and final histology. RESULTS RARC took longer than LRC and ORC. Patients were about 30 times more likely to have a transfusion if they had ORC than if they had RARC (p < 0.0001) and about eight times more likely to have a transfusion if they had LRC compared with RARC (p < 0.006). Patients were four times more likely to have a transfusion if they had ORC as compared with LRC (p < 0.007). Patients were four times more likely to have complications if they had ORC than RARC (p = 0.006) and about three times more likely to have complications with LRC than with RARC (p = 0.02). Hospital stay was mean 19 days after ORC, 16 days after LRC and 10 days after RARC. CONCLUSIONS Despite study limitations, RARC had the lowest transfusion and complication rates and the shortest length of stay, although taking the longest to perform.
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Affiliation(s)
- M S Khan
- Urology Centre, Guy's & Thomas' NHS Foundation Trust, London, UK
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Treiyer A, Saar M, Bütow Z, Kamradt J, Siemer S, Stöckle M. Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes. Int Braz J Urol 2012; 38:324-9. [DOI: 10.1590/s1677-55382012000300005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2012] [Indexed: 11/21/2022] Open
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Gondo T, Yoshioka K, Nakagami Y, Okubo H, Hashimoto T, Satake N, Ozu C, Horiguchi Y, Namiki K, Tachibana M. Robotic Versus Open Radical Cystectomy: Prospective Comparison of Perioperative and Pathologic Outcomes in Japan. Jpn J Clin Oncol 2012; 42:625-31. [DOI: 10.1093/jjco/hys062] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Treiyer A, Saar M, Kopper B, Kamradt J, Siemer S, Stöckle M. [Robotic-assisted laparoscopic radical cystectomy: evaluation of functional and oncological results]. Actas Urol Esp 2011; 35:152-7. [PMID: 21345519 DOI: 10.1016/j.acuro.2010.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/11/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE radical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. We report our experience with 84 consecutive cases of robotic assisted laparoscopic radical cystectomy with regard to perioperative results, pathological outcomes and surgical complications. MATERIALS AND METHODS a total of 84 consecutive patients (70 male and 14 female) underwent robotic radical cystectomy and urinary diversion at our institution from January 2007 to August 2010 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes and complication rate. RESULTS mean age of this cohort was 65.5 years (range 28 to 82). Of the patients 62 underwent ileal conduit diversion, 22 received a neobladder. Mean operating room time for all patients was 261min. (range: 243-618min.) and mean surgical blood loss was 298ml (range: 50-2000ml). 29% of the cases were pT1 or less disease, 38% were pT2, 26% and 7% were pT3 and T4 disease respectively, 15% were node positive. Mean number of lymph nodes removed was 15 (range 1 to 33). In 2 cases (2.4%) there was a positive surgical margin. Mean days to flatus were 2.12, bowel movement 2.87 and discharge home 17.7 (range: 10-33). There were 45 postoperative complications with 11.9% having a major complication (Clavien grade 3 or higher). At a mean followup of 16.7 months 10 patients (11%) had disease recurrence and 2 died of disease. CONCLUSIONS our experience with robotic radical cystectomy for the treatment of bladder cancer suggests that in proper hands this procedure provides acceptable surgical and pathological outcomes.
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Affiliation(s)
- A Treiyer
- Departamento de Urología Robótica, Universidad del Saarland, Homburg/Saar, Alemania.
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Gillion N, Xylinas E, Durand X, Ploussard G, Vordos D, Allory Y, Hoznek A, de la Taille A, Abbou CC, Salomon L. Mid-term oncological control after laparoscopic radical cystectomy in men: a single-centre experience. BJU Int 2011; 108:1180-4. [PMID: 21320272 DOI: 10.1111/j.1464-410x.2010.10054.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE • To assess the mid-term (3 years of follow-up) oncological control of laparoscopic radical cystectomy (LRC) for high-grade muscle-invasive bladder cancer in a well studied male population. PATIENTS AND METHODS • We assessed 40 men with bladder cancer (mean [range] age 66.5 [50-75] years) who underwent LRC and extended pelvic lymphadenectomy at our institution between April 2004 and September 2008. • Of the 40 patients, 13 (32.5%) had a complete laparoscopic procedure (ileal conduit: seven patients; neobladder: five patients; bilateral ureterostomy: one patient) and 27 (67.5%) had an LRC procedure only (ileal conduit: 15 patients; neobladder: 12 patients). RESULTS • No major complications were observed intraoperatively. • The mean operating time was 407 min and the mean blood loss was 720 mL. Four patients (10%) required conversion to open surgery. The mean (range) hospital stay was 10.2 (7-25) days. One patient died of myocardial infarction in the postoperative period. • Pathological analysis showed organ-confined tumours (stage pT0/pT1/pT2/pT3a) in 22 patients (55%) and extravesical disease (pT3/pT4) in 18 (45%). Of the 40 patients, six (15%) had lymph node involvement. The mean (range) number of nodes removed was 19.9 (5-40). • At a mean (range) follow-up period of 36 (0-72) months, 26 patients were alive with no evidence of disease (disease-free survival rate 67%). CONCLUSION • Laparoscopic radical cystectomy is a safe, feasible, and effective alternative to open radical cystectomy (ORC). The 3-year oncological efficacy was comparable with that of ORC.
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Affiliation(s)
- Norman Gillion
- Department of Urology APHP, CHU Henri Mondor, U955 E907 Créteil, France
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Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer. J Robot Surg 2010; 5:101-7. [PMID: 21765876 PMCID: PMC3098974 DOI: 10.1007/s11701-010-0227-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/03/2010] [Indexed: 12/13/2022]
Abstract
To date, no studies have investigated the estimated blood loss (EBL) after full robotic low anterior resection (R-LAR) in a case-matched model, comparing it with the conventional open approach (O-LAR). Forty-nine patients in the R-LAR and 105 in the O-LAR group were matched for age, gender, BMI (body mass index), ASA (American Society of Anesthesiology) class, tumor-node-metastasis (TNM) classification and UICC (Union for International Cancer Control) stage, distance of the lower edge of the tumor from the anal verge, presence of comorbidities, and preoperative hemoglobin (Hb). EBL was significantly higher in the O-LAR group (P < 0.001); twelve units of packed red blood cells were globally transfused in the O-LAR group, compared to one unit only in the R-LAR (P = 0.051). A significantly higher postoperative Hb drop (3.0 vs. 2.4 g/dL, P = 0.015) was registered in the O-LAR patients. The length of hospital stay was much lower for the R-LAR group (8.4 vs. 12.4 days, P < 0.001). The number of harvested lymph nodes (17.4 vs. 13.5, P = 0.006) and extent of distal margin (2.9 vs. 1.9 cm, P < 0.001) were significantly higher in the R-LAR group. Open surgery was confirmed as the sole variable significantly associated (P < 0.001) with blood loss (odds ratio = 4.41, 95% CI 2.06-9.43). It was a confirmed prognosticator of blood loss (P = 0.006) when a preoperative clinical predictive model was built, using multivariate analysis (odds ratio = 3.95, 95% CI 1.47-10.6). In conclusion, R-LAR produced less operative blood loss and less drop in postoperative hemoglobin when compared to O-LAR. Other clinically relevant outcomes were similar or superior to O-LAR.
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Madrazo González Z, García Barrasa A, Rafecas Renau A. Anemia, hierro, transfusión y alternativas terapéuticas. Revisión desde una perspectiva quirúrgica. Cir Esp 2010; 88:358-68. [DOI: 10.1016/j.ciresp.2010.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 11/27/2009] [Accepted: 03/12/2010] [Indexed: 12/31/2022]
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[Radical cystectomy--analysis of postoperative course]. VOJNOSANIT PREGL 2010; 67:649-52. [PMID: 20845668 DOI: 10.2298/vsp1008649j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Radical cystectomy is a method of choice in the therapy of infiltrative bladder cancer. The aim of this research was to analyze postoperative course after radical cystectomy (length of hospitalization, most frequent complications and utilization of antibiotics and transfusions). METHODS We analyzed the records of 82 patients operated on in the Department of Urology, Clinical Center of Vojvodina, in a three-year period. In order to aquire data World Health Organization (WHO) has developed Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Defined daily dose (DDD) is the assumed average maintenance dose per day for a drug use for its main indication. RESULTS Continent urinary derivation was preformed in 23.15% cases. Postoperative complications occurred in 18.29% of patients. Average blood utilization was 2.19 units. Blood utilization for continent derivations (n=48) was 4.6 units, and incontinent ones 3.36 units. Totally 159.33 DDD/100 bed days were used. CONCLUSION When preforming continent derivation there is a significant increase in blood utilization. Frequency of postoperative complications correlates to those reported in the literature.
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Pruthi RS, Nielsen ME, Nix J, Smith A, Schultz H, Wallen EM. Robotic Radical Cystectomy for Bladder Cancer: Surgical and Pathological Outcomes in 100 Consecutive Cases. J Urol 2010; 183:510-4. [PMID: 20006884 DOI: 10.1016/j.juro.2009.10.027] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Indexed: 11/15/2022]
Affiliation(s)
- Raj S. Pruthi
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E. Nielsen
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeff Nix
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Angela Smith
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heather Schultz
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric M. Wallen
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Analysis of gender differences in early perioperative complications following radical cystectomy at a tertiary cancer center using a standardized reporting methodology. Urol Oncol 2010; 28:112-7. [DOI: 10.1016/j.urolonc.2009.04.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 04/20/2009] [Accepted: 04/21/2009] [Indexed: 12/30/2022]
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Ha US, Kim SI, Kim SJ, Cho HJ, Hong SH, Lee JY, Kim JC, Kim SW, Hwang TK. Laparoscopic versus open radical cystectomy for the management of bladder cancer: mid-term oncological outcome. Int J Urol 2009; 17:55-61. [PMID: 19930499 DOI: 10.1111/j.1442-2042.2009.02425.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the mid-term oncological outcome of laparoscopic radical cystectomy (LRC) with those of open radical cystectomy (ORC). METHODS From June 2003 to February 2008, 36 LRCs were carried out at our institute for the treatment of bladder cancer. Clinical and oncological data were retrospectively analyzed. A match-pair comparison with an historical series of 34 patients who were submitted to ORC between 1996 and 2003 was carried out. RESULTS Median follow-up of the LRC group was 21 months (3-56 months). Pathological stage or grade was similar in the two groups. There was no significant difference between the LRC and ORC groups in terms of 3-year overall (64.2% vs 72.6%, respectively; P = 0.682), cancer-specific (73.0% vs 75.3%, respectively; P = 0.951), and recurrence-free survival (70.5% vs 72.5%, respectively; P = 0.715) rates. In a subgroup analysis according to stage, there was also no significant difference in the 3-year disease-specific survival after LRC or ORC for organ-confined (pT1 and pT2; 85.7% vs 83.9%, respectively; P = 0.256) or extravesical disease (pT3 and pT4; 73.3% vs 63.8%, respectively; P = 0.825). CONCLUSION These findings suggest that LRC provides mid-term oncological outcomes similar to those of ORC in the management of bladder cancer.
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Affiliation(s)
- U-Syn Ha
- Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Froehner M, Brausi MA, Herr HW, Muto G, Studer UE. Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 2009; 56:443-54. [PMID: 19481861 DOI: 10.1016/j.eururo.2009.05.008] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 05/05/2009] [Indexed: 02/07/2023]
Abstract
CONTEXT The incidence of bladder cancer increases with advancing age. Considering the increasing life expectancy and the increasing proportion of elderly people in the general population, radical cystectomy will be considered for a growing number of elderly patients who suffer from muscle-invasive or recurrent bladder cancer. OBJECTIVE This article reviews contemporary complication and mortality rates after radical cystectomy in elderly patients and the relationship between age and short-term outcome after this procedure. EVIDENCE ACQUISITION A literature review was performed using the PubMed database with combinations of the following keywords cystectomy, elderly, complications, and comorbidity. English-language articles published in the year 2000 or later were reviewed. Papers were included in this review if the authors investigated any relationship between age and complication rates with radical cystectomy for bladder cancer or if they reported complication rates stratified by age groups. EVIDENCE SYNTHESIS Perioperative morbidity and mortality are increased and continence rates after orthotopic urinary diversion are impaired in elderly patients undergoing radical cystectomy. Complications are frequent in this population, particularly when an extended postoperative period (90 d instead of 30 d) is considered. CONCLUSIONS Although age alone does not preclude radical cystectomy for muscle-invasive or recurrent bladder cancer or for certain types of urinary diversion, careful surveillance is required, even after the first 30 d after surgery. Excellent perioperative management may contribute to the prevention of morbidity and mortality of radical cystectomy, supplementary to the skills of the surgeon, and is probably a reason for the better perioperative results obtained in high-volume centers.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
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Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic Anterior Pelvic Exenteration for Bladder Cancer in the Female: Outcomes and Comparisons to Their Male Counterparts. J Laparoendosc Adv Surg Tech A 2009; 19:23-7. [DOI: 10.1089/lap.2008.0099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Raj S. Pruthi
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heather Stefaniak
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - J. Slade Hubbard
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric M. Wallen
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Braud G, Battisti S, Karam G, Bouchot O, Rigaud J. [Mortality and morbidity of radical cystectomy for bladder cancer in patients over the age of 75]. Prog Urol 2008; 18:1062-7. [PMID: 19041812 DOI: 10.1016/j.purol.2008.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 05/22/2008] [Accepted: 07/06/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the mortality and morbidity of cystectomy and the functional results of the associated diversions in patients over the age of 75 operated for bladder cancer. MATERIAL AND METHODS From 1988 to 2002, 37 patients (29 men and 8 women) aged between 75 to 88 years (median: 79 years) underwent radical cystectomy for bladder cancer. All patients had at least one comorbidity factor, 17 patients were classified as ASA II (45.9%) and 20 were classified as ASA III and IV (54.1%). An external urinary diversion was performed in 35 patients and orthotopic bladder replacement was performed in two patients. The mean follow-up was 21.0 months (range: 0.3-88.6). The mortality, early and late morbidity, and functional results were analyzed. RESULTS There was no intraoperative mortality and the early mortality rate was 5.4% (2/37). The early medical morbidity rate was 24.3%, essentially cardiovascular (pulmonary embolism, myocardial infarction, pulmonary edema), and the early surgical morbidity rate was 2.7%. The late morbidity rate was 27.0%, essentially corresponding to wound complications (peristomal or midline incisional hernias). In terms of functional results, a peristomal incisional hernia with stoma appliance difficulties was observed in 11.4% of patients with an external diversion. One of the two patients treated by bladder replacement performed intermittent self-catheterization and the other was continent during the day and required pads at night. CONCLUSION This study shows that the acceptable mortality and early and late morbidity results allow radical cystectomy to be proposed in patients over the age of 75.
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Affiliation(s)
- G Braud
- Clinique urologique, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
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Park SY, Cho KS, Ham WS, Choi HM, Hong SJ, Rha KH. Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea. J Laparoendosc Adv Surg Tech A 2008; 18:401-4. [PMID: 18503374 DOI: 10.1089/lap.2007.0138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper, we report our initial experience of robot-assisted laparoscopic radical cystoprostatectomy (RLRC) with an ileal conduit urinary diversion (ICUD). Our patient was a 59-year-old man presenting with a clinical T4 invasive transitional cell carcinoma of the bladder and prostate. A RLRC was performed with the da Vinci() robot system (Intuitive Surgical, Mountain View, CA), which has a total of seven degrees of motion (six degrees of freedom and grip), and EndoWrist (Intuitive Surgical) instrumentation. The specimen was extracted through the 8-cm-sized incision in the umbilical trocar site. The ICUD was achieved through a removal site of a specimen by an extracorporeal technique. The total operative time was 340 minutes and the estimated blood loss was 600 mL. The pathologic examination showed a stage T4a, with negative surgical margins. A RLRC can be an alternative to the open technique. We are the first group to perform RLRC in Korea and to report on our technique and outcome.
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Affiliation(s)
- Sung Yul Park
- Department of Urology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
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Smith JA. The case for open radical cystoprostatectomy and urinary reconstruction. J Endourol 2008; 22:2065-7; discussion 2081, 2083. [PMID: 18811544 DOI: 10.1089/end.2008.9743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joseph A Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
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Similar Treatment Outcomes for Radical Cystectomy and Radical Radiotherapy in Invasive Bladder Cancer Treated at a United Kingdom Specialist Treatment Center: In Regard to Kotwal et al. (Int J Radiat Oncol Biol Phys 2008;70:456–463). Int J Radiat Oncol Biol Phys 2008; 71:1601-2; author reply 1602. [DOI: 10.1016/j.ijrobp.2008.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 02/28/2008] [Accepted: 03/26/2008] [Indexed: 11/18/2022]
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Tzortzis V, Gravas S, Mitsogiannis IC, Moutzouris G, Karatzas A, Leventis A, Mpouzalas I, Melekos MD. Impact of stapling devices on radical cystectomy: comparative study between low- and high-volume surgeons. Urology 2008; 71:337-40. [PMID: 18308115 DOI: 10.1016/j.urology.2007.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 09/17/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare effectiveness in terms of blood loss and operative time of stapling devices among surgeons with different levels of surgical volume. METHODS We evaluated a group of 29 male patients with invasive bladder cancer who underwent radical cystectomy by two groups of surgeons. The first group included two high-volume surgeons, and the second group two low-volume surgeons. All cystectomies were performed using the multifire autosuture articulated vascular Endo-GIA. We compared patients with a series of 28 patients who had undergone radical cystectomy during the same period using standard technique by the same surgeons. Blood loss was defined as the difference between the hemoglobin at the beginning and at the end of cystectomy. RESULTS In the group of high-volume surgeons, the mean operative time was 81.4 +/- 17 minutes and 79.3 +/- 20 minutes for the classical and stapler arm, respectively (P = 0.551). In the low-volume surgeons group, the mean operative time was 114.3 +/- 22 minutes and 92.4 +/- 12 minutes for the two methods (P = 0.003). The mean intraoperative blood loss in the experienced surgeons was 2.3 +/- 0.82 g/dL and 1.49 +/- 0.66 g/dL for the classical and stapler arm, respectively (P = 0.008). In the group of low-volume surgeons, the difference in hemoglobin was 3.02 +/- 0.84 g/dL and 1.91 +/- 0.6 g/dL for the two methods (P = 0.02). CONCLUSIONS Stapling devices seem to make cystectomy safer and faster in surgeons with different surgical volumes. The group of low-volume surgeons benefited more.
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Affiliation(s)
- Vassilios Tzortzis
- Department of Urology, University of Thessaly School of Medicine, Larissa, Greece.
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