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Sighinolfi MC, Calcagnile T, Panio E, Assumma S, Sarchi L, Sandri M, Santangelo E, Petix M, Sangalli M, Turri F, Bozzini G, Moschovas MC, Patel V, Rocco B. Robotic-Assisted Radical Cystectomy: Single-Center Analysis of Factors Impacting Clavien ≥ II Complications. Clin Pract 2024; 14:1790-1800. [PMID: 39311293 PMCID: PMC11417726 DOI: 10.3390/clinpract14050143] [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: 01/16/2024] [Revised: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 09/26/2024] Open
Abstract
Despite the advent of robotics and the decreasing rate of complications after radical cystectomy, several factors are renowned to impair the early outcomes of this procedure. The aim of this paper is to provide a multivariate analysis (MVA) of patient and surgical procedure-related variables likely to affect postoperative course and 30-day complication rate. Fifty-five robotic-assisted radical cystectomies (RARCs) performed at a single center from July 2021 to March 2023 were enrolled. Baseline demographics, comorbidities, and intraoperative and postoperative data were collected. Uni- and multivariate analyses were performed to evaluate the relationship with Clavien ≥ II complications arising within 30 days of surgery. A postoperative Clavien ≥ II complication was evident in 15 patients (28%), whereas Clavien ≥ III occurred only in 5 (9%). At MVA, the only independent predictor of Clavien ≥ II complications was a prior neoadjuvant chemotherapy (OR 5.6; 95% CI 1.22-25.3, p = 0.026). Recognized the small sample size, patients who received a prior NAC should deserve special care within the postoperative course.
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Affiliation(s)
| | | | - Enrico Panio
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Simone Assumma
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Luca Sarchi
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Marco Sandri
- Department of Data Methods and Statistics, University of Brescia, 25121 Brescia, Italy
| | | | - Michele Petix
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Mattia Sangalli
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | | | - Marcio Covas Moschovas
- Department of Urology, Advent Health Global Robotics Institute, Celebration, FL 34747, USA
| | - Vipul Patel
- Department of Urology, Advent Health Global Robotics Institute, Celebration, FL 34747, USA
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
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Davidson T, Sjödahl R, Aldman Å, Lennmarken C, Kammerlind AS, Theodorsson E. Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes. Scand J Surg 2024; 113:13-20. [PMID: 37555486 DOI: 10.1177/14574969231186283] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND AIM The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations. METHODS A narrative review was carried out. RESULTS When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs. CONCLUSIONS Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.
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Affiliation(s)
- Thomas Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE 58183, Linkoping Sweden
| | - Rune Sjödahl
- Division of Surgery and Clinical Experimental Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Åke Aldman
- Department of Surgery, Region Kalmar län, Kalmar, Sweden
| | - Claes Lennmarken
- Department for Medical Quality, Region Östergötland, Linkoping, Sweden
| | - Ann-Sofi Kammerlind
- Futurum, Jönköping, Sweden Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
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3
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Francolini G, Ghoshal A, Caini S, Piazzini T, Becherini C, Detti B, Di Cataldo V, Valzano M, Visani L, Salvestrini V, Olmetto E, Desideri I, Meattini I, Livi L. Quality of life after definitive treatment for bladder cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 190:110038. [PMID: 38042498 DOI: 10.1016/j.radonc.2023.110038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Radical cystectomy (RC) is considered the standard treatment for muscle invasive bladder cancer (MIBC). However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g., continent cutaneous urinary diversion and orthotopic neobladder-ONB), have been proposed as alternatives to improve postoperative QoL. Trimodal therapy (TMT) emerged as alternative to surgery. To assess the impact of these treatments from the patients' perspective, we undertook a systematic review and meta-analysis of literature, focusing on studies reporting QoL data about each of the abovementioned approaches. A systematic review was carried out including all prospective and retrospective studies enrolling patientstreated with radical intent for non-metastatic MIBC from 1999 to 2021 (either RC or TMT). All studies included specifically reported QoL for one of the main treatment approaches explored (RC followed by ileal conduit urinary diversion-ICUD, ONB or TMT). Pooled analysis for EORTC QLQ-C30 and BLM-30 questionnaires showed that ONB yielded a significant advantage only for Physical Functioning (pooled mean standardized difference -0.73 SD, p-value 0.019, I 2 = 93 %) and for Emotional Functioning (pooled mean standardized difference -0.16 SD, p-value 0.029, I 2 = 0 %). A trend in favour of higher mean reported values after TMT for Global Health Score, Physical Functioning and Role Functioning was found, if compared to both RC approaches. Significant benefit for ONB if compared to ICUD was detected only for specific subdomains of QoL questionnaires. No direct comparison with TMT is available, but data suggest advantage of this approach when compared to both reconstructive scenarios.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
| | | | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Tessa Piazzini
- Biblioteca Biomedica, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Galletta M, De Pasquale M, Buttitta A, Viganò S, Mucciardi G, Giannarini G, Ficarra V. Combined spinal and epidural anaesthesia for open radical cystectomy: A controlled study. BJUI COMPASS 2024; 5:101-108. [PMID: 38179016 PMCID: PMC10764166 DOI: 10.1002/bco2.221] [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: 11/04/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2024] Open
Abstract
Objectives To evaluate the feasibility of loco-regional anaesthesia and to compare perioperative outcomes between loco-regional and standard general anaesthesia in patients with bladder cancer undergoing open radical cystectomy (ORC). Patients and Methods A single-surgeon cohort of 60 consecutive patients with bladder cancer undergoing ORC with an enhanced recovery after surgery protocol between May 2020 and December 2021 was analysed. A study group of 15 patients operated on under combined spinal and epidural anaesthesia was compared with a control group of 45 patients receiving standard general anaesthesia. Intraoperative outcomes were haemodynamic stability, estimated blood loss, intraoperative red blood cell transfusion rate, and anaesthesia time. Postoperative outcomes were pain assessment 24 h after surgery, time to mobilisation, return to oral diet, time to bowel function recovery, length of stay and rate of 90-day complications. Results No patients required conversion from loco-regional to general anaesthesia. All patients in both groups were haemodynamically stable. No significant differences between groups were observed for all other intraoperative outcomes, except for a shorter anaesthesia time in the study versus control group (250 vs. 290 min, p = 0.01). Pain visual score 24 h after surgery was significantly lower in the study versus control group (0 vs. 2, p < 0.001). No significant differences were observed for all other postoperative outcomes, with a comparable time to bowel function recovery (5 days in each group for stool passage), and 90-day complication rate (46.6% vs. 42.2% for the study vs. control group, p = 0.76). Conclusion Our exploratory, controlled study confirmed the feasibility, safety and effectiveness of a pure loco-regional anaesthesia in patients with bladder cancer undergoing ORC. No significant differences were observed in intra- and postoperative outcomes between loco-regional and general anaesthesia, except for a significantly shorter anaesthesia time and greater pain reduction in the early postoperative period for the former.
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Affiliation(s)
- Maria Galletta
- Gaetano Barresi Department of Human and Paediatric Pathology, Anaesthesiology SectionUniversity of MessinaMessinaItaly
| | - Maria De Pasquale
- Gaetano Barresi Department of Human and Paediatric Pathology, Anaesthesiology SectionUniversity of MessinaMessinaItaly
| | - Alessandro Buttitta
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
| | - Silvia Viganò
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
| | | | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
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Khetrapal P, Wong JKL, Tan WP, Rupasinghe T, Tan WS, Williams SB, Boorjian SA, Wijburg C, Parekh DJ, Wiklund P, Vasdev N, Khan MS, Guru KA, Catto JWF, Kelly JD. Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials. Eur Urol 2023; 84:393-405. [PMID: 37169638 DOI: 10.1016/j.eururo.2023.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/12/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
CONTEXT Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear. OBJECTIVE This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures. EVIDENCE ACQUISITION Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022. EVIDENCE SYNTHESIS Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03-0.39, p = 0.02) than and similar complication rates to ORC. ORC was associated with higher thromboembolic events (odds ratio [OR] 1.84, 95% CI 1.02-3.31, p = 0.04). ORC was associated with more blood loss (MD 322 ml, 95% CI 193-450, p < 0.001) and transfusions (OR 2.35, 95% CI 1.65-3.36, p < 0.001), but shorter operative time (MD 76 min, 95% CI 39-112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI -1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54-1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29-0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4-15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients. CONCLUSIONS RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events. PATIENT SUMMARY This study compares robot-assisted keyhole surgery with open surgery for bladder cancer. The robot-assisted approach offered less blood loss, shorter hospital stays, and fewer blood clots. No other differences were seen.
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Affiliation(s)
- Pramit Khetrapal
- Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, Barts Health NHS Trust, London, UK; Department of Urology, University College London Hospital, London, UK.
| | - Joanna Kae Ling Wong
- Department of Anaesthetics, Homerton University Hospital NHS Foundation Trust, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Wei Phin Tan
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Thiara Rupasinghe
- Division of Surgery & Interventional Sciences, University College London, London, UK
| | - Wei Shen Tan
- Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Carl Wijburg
- Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Dipen J Parekh
- Desai Sethi Urology Institute at the Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Nikhil Vasdev
- Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK; School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | | | - Khurshid A Guru
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - James W F Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John D Kelly
- Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
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Chu C, Pietzak E. Immune mechanisms and molecular therapeutic strategies to enhance immunotherapy in non-muscle invasive bladder cancer: Invited review for special issue "Seminar: Treatment Advances and Molecular Biology Insights in Urothelial Carcinoma". Urol Oncol 2023; 41:398-409. [PMID: 35811207 PMCID: PMC10167944 DOI: 10.1016/j.urolonc.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/12/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) has been the standard of care for patients with high-risk non non-muscle invasive bladder cancer (NMIBC) for over four decades. Despite its success as a cancer immunotherapy, disease recurrence and progression remain common. Current efforts are focused on developing effective and well-tolerated alternatives to BCG and salvage bladder preservation therapies after BCG has failed. The focus of this review is to synthesize our current understanding of the molecular biology and tumor immune microenvironment of NMIBC to provide rationale for existing and emerging therapeutic targets. We highlight recent and ongoing clinical trials and define the current treatment landscape, challenges, and future directions of salvage treatment. Combination regimens that are rationally designed will be needed to make meaningful therapeutic advancements. Investigations into the molecular underpinnings of NMIBC are leading to the emergence of predictive molecular biomarkers that provide greater insight into the clinical heterogeneity of NMIBC and enable us to identify drivers of treatment resistance and new therapeutic targets.
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Affiliation(s)
- Carissa Chu
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene Pietzak
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Weill Cornell Medical College, New York, NY.
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Sathianathen NJ, Pan HY, Furrer M, Thomas B, Dundee P, Corcoran N, Weight CJ, Konety B, Nair R, Lawrentschuk N. Comparison of Robotic vs Open Cystectomy: A Systematic Review. Bladder Cancer 2023; 9:253-269. [PMID: 38993188 PMCID: PMC11181804 DOI: 10.3233/blc-220065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/04/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND The benefits of a robot-assisted radical cystectomy (RARC) compared to an open approach is still under debate. Initial data on RARC were from trials where urinary diversion was performed by an extracorporeal approach, which does not represent a completely minimally invasive procedure. There are now updated data for RARC with intracorporeal urinary diversion that add to the evidence profile of RARC. OBJECTIVE To perform a systematic review and meta-analysis of the effectiveness of RARC compared with open radical cystectomy (ORC). MATERIALS AND METHODS Multiple databases were searched up to May 2022. We included randomised trials in which patients underwent RARC and ORC. Oncological and safety outcomes were assessed. RESULTS Seven trials of 907 participants were included. There were no differences seen in primary outcomes: disease progression [RR 0.98, 95% CI 0.78 to 1.23], major complications [RR 0.95, 95% CI 0.72 to 1.24] and quality of life [SMD 0.05, 95% CI -0.13 to 0.38]. RARC resulted in a decreased risk of perioperative blood transfusion [RR 0.57, 95% CI 0.43 to 0.76], wound complications [RR 0.34, 95% CI 0.21 to 0.55] and reduced length of hospital stay [MD -0.62 days, 95% CI -1.11 to -0.13]. However, there was an increased risk of developing a ureteric stricture [RR 4.21, 95% CI 1.07 to 16.53] in the RARC group and a prolonged operative time [MD 70.4 minutes, 95% CI 34.1 to 106.7]. The approach for urinary diversion did not impact outcomes. CONCLUSION RARC is an oncologically safe procedure compared to ORC and provides the benefits of a minimally invasive approach. There was an increased risk of developing a ureteric stricture in patients undergoing RARC that warrants further investigation. There was no difference in oncological outcomes between approaches.
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Affiliation(s)
- Niranjan J. Sathianathen
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Henry Y.C. Pan
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Marc Furrer
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Benjamin Thomas
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Philip Dundee
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Niall Corcoran
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Urology, Western Health, Footscray, VIC, Australia
- Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | | | | | - Rajesh Nair
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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Lind AK, Liedberg F, Aljabery F, Bläckberg M, Gårdmark T, Hosseini A, Jerlström T, Ströck V, Stenzelius K. Health-related quality of life prior to and 1 year after radical cystectomy evaluated with FACT-G and FACT-VCI questionnaires. Scand J Urol 2023; 58:76-83. [PMID: 37747157 DOI: 10.2340/sju.v58.11952] [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: 03/31/2023] [Accepted: 08/01/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The aim of this study was to investigate health-related quality of life (HRQoL) before and 1 year after radical cystectomy in relation to age and gender. METHODS This prospective study involves 112 men and 40 women with bladder cancer treated with radical cystectomy between 2015 and 2018. HRQoL was assessed preoperatively and 1 year post-surgery through Functional Assessment of Cancer Therapy Scale - General (FACT-G) and Functional Assessment of Cancer Therapy Scale - Vanderbilt Cystectomy Index (FACT-VCI) questionnaires. The median age of the 152 patients was 71.5 years. RESULTS Preoperatively, emotional and functional well-being were negatively affected. Physical, emotional and functional well-being presented higher values 1 year after surgery compared to before radical cystectomy, that is, better HRQoL. Social well-being showed a reduction, especially regarding closeness to partner and support from family. Men and women were equally satisfied with their sex life before radical cystectomy, but less so 1 year after, where men were less satisfied compared to women. Additionally, one out of five patients reported that they had to limit their physical activities, were afraid of being far from a toilet and were dissatisfied with their body appearance after surgery. CONCLUSIONS Recovery regarding HRQoL was ongoing 1 year after radical cystectomy. Patients recovered in three out of four dimensions of HRQoL, but social well-being was still negatively affected 1 year after treatment. Sexual function after radical cystectomy was exceedingly limited for both men and women. An individual sexual rehabilitation plan involving the couple with special intention to encourage intimacy, might not only improve sexual life but also have a positive effect on social well-being as a consequence.
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Affiliation(s)
- Anna Karin Lind
- Department of Urology, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Mats Bläckberg
- Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Abofazl Hosseini
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Karin Stenzelius
- Malmö University, Department of Care Science, Faculty of Health and Society, Malmö, Sweden
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9
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Han JH, Ku JH. Robot-assisted radical cystectomy: Where we are in 2023. Investig Clin Urol 2023; 64:107-117. [PMID: 36882169 PMCID: PMC9995950 DOI: 10.4111/icu.20220384] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 03/02/2023] Open
Abstract
Open radical cystectomy (ORC) is associated with high rates of perioperative morbidity and mortality, owing to its extensive surgical nature and the high frequency of multiple co-morbidities among patients. As an alternative, robot-assisted radical cystectomy (RARC) has been increasingly adopted worldwide, being a reliable treatment option that utilizes minimally invasive surgery. Seventeen years have passed since the advent of the RARC, and comprehensive long-term follow-up data are now becoming available. The present review focuses on the current knowledge of RARC in 2023, and analyzes various aspects, including oncological outcomes, peri/post-operative complications, post-operative quality of life (QoL) change, and cost-effectiveness. Oncologically, RARC showed comparable oncological outcomes to ORC. With regard to complications, RARC was associated with lower estimated blood loss, lower intraoperative transfusion rates, shorter length of stay, lower risk of Clavien-Dindo grade III-V complications, and lower 90-day rehospitalization rates than ORC. In particular, RARC with intracorporeal urinary diversion (ICUD) performed by high-volume centers significantly reduced the risk of post-operative major complications. In terms of post-operative QoL, RARC with extracorporeal urinary diversion (ECUD) showed comparable results to ORC, while RARC with ICUD was superior in some respects. As the RARC implementation rate increases and the learning curve is overcome, more prospective studies and randomized controlled trials with large-scale patients are expected to be conducted in the future. Accordingly, sub-group analysis in various groups such as ECUD, ICUD, continent and non-continent urinary diversion, etc. is considered to be possible.
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Affiliation(s)
- Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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10
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Robot-Assisted Radical Cystectomy: A Single-Center Experience and a Narrative Review of Recent Evidence. Diagnostics (Basel) 2023; 13:diagnostics13040714. [PMID: 36832202 PMCID: PMC9955211 DOI: 10.3390/diagnostics13040714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 02/16/2023] Open
Abstract
Radical cystectomy represents one of the most challenging surgical procedures, exhibiting a high morbidity rate. The transition to minimally invasive surgery in the field has been steep, due to either the technical complexity and prior concerns of atypical recurrences and/or peritoneal spread. More recently, a larger series of RCTs has proven the oncological safety of robot-assisted radical cystectomy (RARC). Beyond survival outcomes, the comparison between RARC and open surgery in terms of peri-operative morbidity is still ongoing. We present a single-center experience of RARC with intracorporeal urinary diversion. Overall, 50% of patients had an intracorporeal neobladder reconstruction. The series confirms a low rate of complications (Clavien Dindo ≥ IIIa 7.5%) and wound infections (2.5%) and the absence of thromboembolic events. No atypical recurrences were found. To discuss these outcomes, we reviewed the literature related to RARC including level-1 evidence. PubMed and Web of Science searches were performed using the medical subject terms "robotic radical cystectomy" and "randomized controlled trial (RCT)". Six unique RCTs comparing robot and open surgery were found. Two clinical trials dealt with RARC with an intracorporeal reconstruction of UD. Pertinent clinical outcomes are summarized and discussed. In conclusion, RARC is a complex but feasible procedure. The transition from extracorporeal urinary diversion (UD) to a complete intracorporeal reconstruction could be the key to improving peri-operative outcomes and reducing the whole morbidity of the procedure.
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Grobet-Jeandin E, Pinar U, Parra J, Rouprêt M, Seisen T. Health-related quality of life after curative treatment for muscle-invasive bladder cancer. Nat Rev Urol 2023; 20:279-293. [PMID: 36653671 DOI: 10.1038/s41585-022-00693-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/19/2023]
Abstract
Muscle-invasive bladder cancer (MIBC) is an aggressive disease for which the gold-standard treatment is radical cystectomy (RC) in combination with cisplatin-based neoadjuvant chemotherapy. Bladder-sparing strategies such as trimodal therapy (TMT) have also emerged to improve health-related quality of life (HRQoL) of patients. However, an improved understanding of the effect of all these treatment modalities on HRQoL is essential to provide personalized patient care. Different combinations of generic, cancer-specific and bladder cancer-specific questionnaires can be used as instruments for HRQoL evaluation in patients with MIBC before and after curative treatments, which can largely affect multiple domains of HRQoL including general health as well as physical, functional, social and emotional well-being. However, diagnosis of MIBC per se is also likely to affect HRQoL, and the perspective of cure after RC or TMT could induce a return to baseline HRQoL values for most of these domains. A considerable amount of data on HRQoL after RC is available, but conflicting results have been reported regarding the effect of urinary diversion (ileal conduit or orthotopic neobladder) and surgical approach (open or robotic surgery) on patient quality of life. Data on HRQoL after TMT are scarce, and additional comparative studies including patients receiving RC (especially using ileal orthotopic neobladder) are needed.
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Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France. .,Division of Urology, Geneva University Hospitals, Geneva, Switzerland.
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| | - Jérôme Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
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Robotic-assisted Versus Laparoscopic Versus Open Radical Cystectomy—A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2022:S2405-4569(22)00285-1. [DOI: 10.1016/j.euf.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/20/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
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13
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Venkatramani V, Reis IM, Gonzalgo ML, Castle EP, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Parekh DJ. Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2148329. [PMID: 35171260 PMCID: PMC8851298 DOI: 10.1001/jamanetworkopen.2021.48329] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE No data exist on time to recovery of patient-reported and performance-related measures of functional independence after radical cystectomy (open or robotic). OBJECTIVE To determine recovery of functional independence after radical cystectomy and whether robot-assisted radical cystectomy (RARC) is associated with any advantage over open procedures. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis from the RAZOR (Randomized Open vs Robotic Cystectomy) trial were used. RAZOR was a phase 3 multicenter noninferiority trial across 15 academic medical centers in the US from July 1, 2011, to November 18, 2014, with a median follow-up of 2 years. Participants included the per-protocol population (n = 302). Data were analyzed from February 1, 2017, to May 1, 2021. INTERVENTIONS Robot-assisted radical cystectomy or open radical cystectomy (ORC). MAIN OUTCOMES AND MEASURES Patient-reported (activities of daily living [ADL] and independent ADL [iADL]) and performance-related (hand grip strength [HGS] and Timed Up & Go walking test [TUGWT]) measures of independence were assessed. Patterns of postoperative recovery for the entire cohort and comparisons between RARC and ORC were performed. Exploratory analyses to assess measures of independence across diversion type and to determine whether baseline impairments were associated with 90-day complications or 1-year mortality were performed. FINDINGS Of the 302 patients included in the analysis (254 men [84.1%]; mean [SD] age at consent, 68.0 [9.7] years), 150 underwent RARC and 152 underwent ORC. Baseline characteristics were similar in both groups. For the entire cohort, ADL, iADL, and TUGWT recovered to baseline by 3 postoperative months, whereas HGS recovered by 6 months. There was no difference between RARC and ORC for ADL, iADL, TUGWT, or HGS scores at any time. Activities of daily living recovered 1 month after RARC (mean estimated score, 7.7 [95% CI, 7.3-8.0]) vs 3 months after ORC (mean estimated score, 7.5 [95% CI, 7.2-7.8]). Hand grip strength recovered by 3 months after RARC (mean estimated HGS, 29.0 [95% CI, 26.3-31.7] kg) vs 6 months after ORC (mean estimated HGS, 31.2 [95% CI, 28.8-34.2] kg). In the RARC group, 32 of 90 patients (35.6%) showed a recovery in HGS at 3 months vs 32 of 88 (36.4%) in the ORC group (P = .91), indicating a rejection of the primary study hypothesis for HGS. Independent ADL and TUGWT recovered in 3 months for both approaches. Hand grip strength showed earlier recovery in patients undergoing continent urinary diversion (mean HGS at 3 months, 31.3 [95% CI, 27.7-34.8] vs 33.9 [95% CI, 30.5-37.3] at baseline; P = .09) than noncontinent urinary diversion (mean HGS at 6 months, 27.4 [95% CI, 24.9-30.0] vs 29.5 [95% CI, 27.2-31.9] kg at baseline; P = .02), with no differences in other parameters. Baseline impairments in any parameter were not associated with 90-day complications or 1-year mortality. CONCLUSIONS AND RELEVANCE The results of this secondary analysis suggest that patients require 3 to 6 months to recover baseline levels after radical cystectomy irrespective of surgical approach. These data will be invaluable in patient counseling and preparation. Hand grip strength and ADL tended to recover to baseline earlier after RARC; however, there was no difference in the percentage of patients recovering when compared with ORC. Further study is needed to assess the clinical significance of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01157676.
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Affiliation(s)
- Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Isildinha M. Reis
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark L. Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Erik P. Castle
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Michael E. Woods
- Department of Urology, University of North Carolina at Chapel Hill
| | - Robert S. Svatek
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio
| | - Alon Z. Weizer
- Department of Urology, University of Michigan, Ann Arbor
| | | | | | - Tracey L. Krupski
- Department of Urology, University of Virginia Health Science Center, Charlottesville
| | - Norm D. Smith
- Department of Urology, North Shore University Health System, Evanston, Illinois
| | | | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus L. Quek
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Atreya Dash
- Department of Urology, University of Washington, Seattle
| | - Dipen J. Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Grauer R, Wiklund NP. Update on robotic cystectomy. Curr Opin Urol 2021; 31:537-541. [PMID: 34506337 DOI: 10.1097/mou.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article aims to discuss recently published (2019-2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics. RECENT FINDINGS RARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming. SUMMARY ORC is the current 'gold standard' management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed-informing further adoption of the technique.
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Affiliation(s)
- Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Prognostic value of prostate volume in non-muscle invasive bladder cancer. Sci Rep 2021; 11:18784. [PMID: 34552102 PMCID: PMC8458356 DOI: 10.1038/s41598-021-98045-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 12/09/2022] Open
Abstract
There is evidence that a history of benign prostatic hyperplasia increases the incidence of bladder cancer, and treatment with 5-alpha reductase inhibitor or androgen deprivation therapy reduces recurrence of non-muscle invasive bladder cancer. We aimed to evaluate whether prostate volume affects its prognosis. We reviewed medical records of men who underwent transurethral resection of bladder tumor due to non-muscle invasive bladder cancer from January 2012 to December 2017. Patients were divided into two groups based on prostate volume measured by computed tomography (group 1: 264 patients with ≤ 30 mL, group 2: 124 patients with > 30 mL). Propensity score matching analysis was used for adjust selection bias, and then assessed recurrence-free survival and progression-free survival. With a median follow up duration of 52 months, group 1 showed higher 5-year recurrence-free and progression-free survival (69.3% vs 47.0%, p = 0.001; 96.7% vs 87.7%, p = 0.002). Further, cox-regression analysis showed that tumor size (HR = 1.292 p < 0.001), multifocal tumor (HR = 1.993, p < 0.001), adjuvant intravesical therapy (chemotherapy: HR = 0.580, p = 0.037 and bacillus Calmette-Guérin: HR = 0.542, p = 0.004) and prostate volume (HR = 2.326, p < 0.001) were significant predictors of recurrence-free survival. Prostate volume (HR = 2.886, p = 0.014) was also associated with PFS with age (HR = 1.043, p = 0.044) and tumor grade (HR = 3.822, p = 0.013). We conclude higher prostate volume is associated with worse recurrence and progression-free survival in non-muscle invasive bladder cancer.
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Tyson M, Andrews P, Cheney S, Humphreys M. Single Incision Robotic Cystectomy and Hybrid Orthotopic Neobladder Reconstruction: A Step by Step Description. Urology 2021; 156:285-288. [PMID: 34274390 DOI: 10.1016/j.urology.2021.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a new technique for single incision robotic cystectomy and Studer-type ileal neobladder using the single-port (SP) da Vinci SP robotic platform. METHODS In April 2021, a 71 year-old patient underwent a single incision robotic cystectomy and orthotopic Studer-type ileal neobladder using the single-port da Vinci SP robotic platform for cT2, cN0 urothelial carcinoma of the bladder. He was not a candidate for neoadjuvant cisplatin-based combination chemotherapy and declined participation in a clinical trial. RESULTS Total operative time was 554 minutes and estimated blood loss was 250 cc. He was discharged on postoperative day six without developing any Clavien complications. He underwent adjuvant chemotherapy for node-positive disease and follow-up through June 2021 was notable for the absence of any significant complications or readmissions. We provide a comprehensive discussion of the required instrumentation, a description of the technique with illustrations, and discuss the advantages and disadvantages of this technology as it pertains to cystectomy and urinary diversion. CONCLUSION We make no claim regarding the superiority of this technique over others, only that it is technically feasible and that the approach holds promise.
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Affiliation(s)
- Mark Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ.
| | - Paul Andrews
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | - Scott Cheney
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
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17
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Abozaid M, Tan WS, Khetrapal P, Baker H, Duncan J, Sridhar A, Briggs T, Selim M, Abdallah MM, Elmahdy AA, Elserafy F, Kelly JD. Recovery of health-related quality of life in patients undergoing robot-assisted radical cystectomy with intracorporeal diversion. BJU Int 2021; 129:72-79. [PMID: 34092021 DOI: 10.1111/bju.15505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the health-related quality of life (HRQoL) after robot-assisted radical cystectomy and intracorporeal urinary diversion (iRARC), and to identify factors impacting on return to baseline. PATIENTS AND METHODS Consecutive patients undergoing iRARC between January 2016 and December 2017 completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (EORTC-QLQ-C30) and EORTC-QLQ-Muscle-Invasive Bladder Cancer Module (EORTC-QLQ-BLM30) questionnaires before surgery and had a minimum of 12 months follow-up postoperatively. RESULTS A total of 76 patients met the inclusion criteria at 12 months. Neobladder (NB) cases (n = 24) were younger (57.0 vs 71.0 years, P < 0.001) and fitter than ileal conduit (IC) cases (n = 52), and had higher physical (100.0 vs 93.3, P = 0.039) and sexual functioning (66.7 vs 50.0, P = 0.013) scores at baseline. Longitudinal analysis of the EORTC-QLQ-C30 showed that physical (NB: 93.3 vs 100.0, P = 0.020; IC: 80.0 vs 93.3, P < 0.001) and role functioning scores (NB: 83.3 vs 100.0, P = 0.010; IC: 83.3 vs 100.0, P = 0.017) decreased and fatigue score (NB: 22.2 vs 11.1, P = 0.026; IC: 33.3 vs 22.2, P = 0.008) increased at 3 months in both diversion groups. Scores returned to baseline at 6 months except physical functioning score in IC patients that remained below baseline until 12 months (86.7 vs 93.3, P = 0.012). The global HRQoL score did not show significant change postoperatively in both groups. A major 90-day Clavien-Dindo complication was a significant predictor (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02-0.62; P = 0.012) of deteriorated global HRQoL score at 3 months, while occurrence of a late complication (OR 0.14, 95% CI 0.03-0.65; P = 0.013) was a predictor of deteriorated global HRQoL score at 12 months. Longitudinal analysis of the EORTC-QLQ-BLM30 showed that urinary problems (NB: 14.3 vs 38.3, P < 0.001; IC: 5.6 vs 19.1, P < 0.001) and future perspective (NB: 33.3 vs 44.4, P = 0.004; IC: 22.2 vs 44.4, P < 0.001) scores were better than baseline at 3 months. Sexual function deteriorated significantly at 3 months (NB: 8.3 vs 66.7, P < 0.001; IC: 4.2 vs 50.0, P < 0.001) and then showed improvement at 12 months but was still below baseline (NB: 33.3 vs 66.7, P = 0.001; IC: 25.0 vs 50.0, P < 0.001). Involvement in penile rehabilitation was shown to be a significant predictor (β 18.62, 95% CI 6.06-30.45; P = 0.005) of higher sexual function score at 12 months. CONCLUSION While most functional domains and symptoms scales recover to or exceed baseline within 6 months of iRARC, physical function remains below baseline in IC patients up to 12 months. Global HRQoL is preserved for both types of urinary diversion; however, postoperative complications seem to be the main driving factor for global HRQoL. Sexual function is adversely affected after iRARC suggesting that structured rehabilitation of sexual function should be an integral part of the RC pathway.
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Affiliation(s)
- Mohammed Abozaid
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Wei Shen Tan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Pramit Khetrapal
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Hilary Baker
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jacqueline Duncan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Tim Briggs
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mohamed Selim
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Alaa Aldin Elmahdy
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Fatma Elserafy
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - John D Kelly
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery. World J Urol 2021; 39:3979-3991. [PMID: 33963916 PMCID: PMC8519897 DOI: 10.1007/s00345-021-03713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To validate a German translation of the convalescence and recovery evaluation (CARE) as an electronic patient-reported outcome measure (ePROM) and use it to assess recovery after major urological surgery. Methods The CARE questionnaire was provided to patients scheduled for major urological surgery preoperatively, at discharge and 6 weeks postoperatively, using an ePROM system. Cronbach’s alpha, inter-scale correlations and confirmatory factor analysis (CFA) were used to validate the translation. Mixed linear regression models were used to identify factors influencing CARE results, and a multivariable logistic regression analysis was done to determine the predictive value of CARE results on quality of life (QoL). Results A total of 283 patients undergoing prostatectomy (n = 146, 51%), partial/radical nephrectomy (n = 70, 25%) or cystectomy (n = 67, 24%) responded to the survey. Internal consistency was high (α = 0.649–0.920) and the CFA showed a factor loading > 0.5 in 17/27 items. Significant main effects were found for the time of survey and type of surgery, while a time by type interaction was only found for the gastrointestinal subscale (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{(4)}^{2}$$\end{document}χ(4)2 = 30.37, p < 0.0001) and the total CARE score (TCS) (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{(4)}^{2}$$\end{document}χ(4)2 = 13.47, p = 0.009) for cystectomy patients, meaning a greater score decrease at discharge and lower level of recovery at follow-up. Complications demonstrated a significant negative effect on the TCS (\documentclass[12pt]{minimal}
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\begin{document}$$\chi_{(2)}^{2}$$\end{document}χ(2)2 = 8.61, p = 0.014). A high TCS at discharge was an independent predictor of a high QLQ-C30 QoL score at follow-up (OR = 5.26, 95%-CI 1.42–19.37, p = 0.013). Conclusion This German translation of the CARE can serve as a valid ePROM to measure recovery and predict QoL after major urological surgery.
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Einfluss der Zystektomie-Methode auf die gesundheitsbezogene Lebensqualität. Aktuelle Urol 2021; 52:112-114. [PMID: 33822340 DOI: 10.1055/a-1238-6122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nason GJ, Ajib K, Tan GH, Kulkarni GS. Radical cystectomy-what is the optimal surgical approach? Transl Androl Urol 2020; 9:2308-2312. [PMID: 33209702 PMCID: PMC7658163 DOI: 10.21037/tau-20-880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Gregory J Nason
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Guan-Hee Tan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Boris RS, Calaway AC. Evaluating the impact of minimally invasive vs open trials in urologic malignancy. Are we missing the mark? Urol Oncol 2020; 38:643-645. [DOI: 10.1016/j.urolonc.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 11/24/2022]
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