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Ma R, Sheybaee Moghaddam F, Ghoreifi A, Ladi-Seyedian S, Cai J, Miranda G, Aron M, Schuckman A, Desai M, Gill I, Daneshmand S, Djaladat H. The effect of enhanced recovery after surgery on oncologic outcome following radical cystectomy for urothelial bladder carcinoma. Surg Oncol 2024; 54:102061. [PMID: 38513372 DOI: 10.1016/j.suronc.2024.102061] [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: 11/13/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Limited data are available regarding the effect of enhanced recovery after surgery (ERAS) protocols on the long-term outcomes of radical cystectomy (RC) in bladder cancer patients. The aim of this study is to evaluate the oncological outcomes in patients who underwent RC with ERAS protocol. METHODS We reviewed the records of patients who underwent RC for primary urothelial bladder carcinoma with curative intent from January 2003 to August 2022. The primary and secondary outcomes were recurrence-free (RFS) and overall survival (OS). Multivariable Cox regression analysis was performed to evaluate the effect of ERAS on oncological outcomes. RESULTS A total of 967 ERAS patients and 1144 non-ERAS patients were included in this study. The RFS rates at 1, 3, and 5 years after RC were 81%, 71.5%, and 69% in the ERAS cohort, respectively. This rate in the non-ERAS group was 81%, 71%, and 67% at 1, 3, and 5 years after RC, respectively (P = 0.50). However, ERAS patients had significantly better OS with 86%, 73%, and 67% survival rates at 1, 3, and 5 years compared to 84%, 68%, and 59.5% survival rates in the non-ERAS group, respectively (P = 0.002). In multivariable analysis adjusting for other relevant factors, ERAS was no longer independently associated with recurrence-free (HR = 0.96, 95% CI 0.76-1.22, P = 0.75) or overall survival (HR = 0.84, 95% CI 0.66-1.09, P = 0.28) following RC. CONCLUSION ERAS protocols are associated with a shorter hospital stay, yet with no impact on long-term oncologic outcomes in patients undergoing RC for bladder cancer.
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Affiliation(s)
- Runzhuo Ma
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Sanam Ladi-Seyedian
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Anne Schuckman
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, CA, USA.
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Pan DL, Zhang LF, Li XJ, Zhang KP, Gao PF, Yang B, Li NC. Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer. BMC Cancer 2024; 24:159. [PMID: 38297199 PMCID: PMC10829394 DOI: 10.1186/s12885-024-11816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.
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Affiliation(s)
- Dong-Liang Pan
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Lu-Fang Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China.
| | - Xiao-Jian Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ke-Ping Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Peng-Fei Gao
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Bing Yang
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ning-Chen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
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Kumada N, Nakane K, Yamada T, Tomioka-Inagawa R, Sugino F, Namiki S, Kawase M, Kawase K, Takeuchi S, Nakai C, Kato D, Takai M, Iinuma K, Tobisawa Y, Koie T. Utility and safety of robot-assisted radical cystectomy in older patients with bladder cancer. MINIM INVASIV THER 2023; 32:307-313. [PMID: 37607213 DOI: 10.1080/13645706.2023.2249986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
Introduction: This study aimed to investigate the efficacy and safety of robot-assisted radical cystectomy (RARC) in older patients with bladder cancer (BCa).Material and methods: We reviewed the clinical and pathological records of 110 patients with BCa who underwent RARC at Gifu University Hospital between February 2019 and January 2023. Older patients were defined as those with BCa aged ≥ 75 years. The enrolled patients were divided into two groups: those aged < 75 years (Group I) and those aged ≥ 75 years (Group II). Oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS), were the primary endpoints of the study; the secondary endpoints were the surgical and pathological outcomes.Results: A shorter console time, less blood loss, and reduced time to postoperative fluid and food intake in Group II may be attributed to the fact that more patients opted for ureterocutaneostomy in Group II than in Group I. In all patients, the three-year OS and RFS rates were 84.7% and 88.5%, respectively. There were no significant differences in OS or RFS between the two groups. (p = .403, p = .963, respectively).Conclusions: RARC appears to be a safe and useful treatment option for older patients with BCa.
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Affiliation(s)
- Naotaka Kumada
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Toyohiro Yamada
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | | | - Fumiya Sugino
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Sanae Namiki
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Kota Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Shinichi Takeuchi
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Chie Nakai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Daiki Kato
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
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Kim GH, Yuk HD, Jeong CW, Kwak C, Ku JH. Renal function change after radical cystectomy for urothelial carcinoma patients with a solitary kidney may be independent of urinary diversion type. Investig Clin Urol 2023; 64:457-465. [PMID: 37668201 PMCID: PMC10482667 DOI: 10.4111/icu.20230065] [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: 02/22/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE To compare renal function change by urinary diversion (UD) type (ileal conduit [IC] vs. neobladder [NB]) in patients with a single kidney who underwent radical cystectomy (RC) due to bladder cancer. MATERIALS AND METHODS We evaluated the renal function change in 86 patients with a single kidney who underwent RC between January 1999 and August 2022. Renal function was assessed using serum creatinine, serum estimated glomerular filtration rate (eGFR), eGFR difference value (preoperative and follow-up values), and eGFR difference proportion (eGFR difference value/preoperative eGFR) at 1, 3, 6, 12, 24, 36, 48, and 60 months. In addition, multiple definitions of eGFR decline were evaluated: 10 points, 10%, and 20% decline in eGFR. Cox regression models were used to identify risk factors of eGFR decline-free, recurrence-free, overall, and cancer-specific survival rates. RESULTS A total of 54 patients (62.8%) underwent IC, whereas 32 (37.2%) underwent NB. Baseline characteristics were similar between the two groups except for age and body mass index. Renal functions over time by various methods did not differ significantly between the IC and NB groups. Furthermore, eGFR decline-free survival rate using different definitions was similar between the IC and NB groups. Overall survival, recurrence-free survival, and cancer-specific-free survival rates were not different between the IC and NB groups. CONCLUSIONS UD type (IC vs. NB) did not impact the renal function change of patients with a single kidney who underwent RC. Therefore, patients with a single kidney might be considered to be an indication of NB.
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Affiliation(s)
- Gyeong Hun Kim
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Cochetti G, Paladini A, Del Zingaro M, Ciarletti S, Pastore F, Massa G, De Angelis L, Mearini E. Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications. Front Surg 2023; 10:1157684. [PMID: 37383384 PMCID: PMC10293791 DOI: 10.3389/fsurg.2023.1157684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Radical cystectomy with pelvic lymph node dissection is the gold standard treatment for non-metastatic muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. For years, the traditional open surgery approach was the only viable option. The widespread of robotic surgery led to its employment also in radical cystectomy to reduce complication rates and improve functional outcomes. Regardless of the type of approach, radical cystectomy is a procedure with high morbidity and not negligible mortality. Data available in the literature show how the use of staplers can offer valid functional outcomes, with an acceptable rate of complications shortening the operative time. The aim of our study was to describe the perioperative outcomes and complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) using a mechanical stapler. Material and methods From January 2015 to May 2021, we enrolled patients who underwent RARC with pelvic node dissection and stapled ICUD (ileal conduit or ileal Y-shaped neobladder according to the Perugia ileal neobladder) in our high-volume center. Demographic features, perioperative outcomes and early (≤30 days) and late (>90 days) post-operative complications according to the Clavien-Dindo classification, were recorded for each patient. We also analyzed the potential linear correlation between demographic, pre-operative as well as operative features and the risk of post-operative complications. Results Overall, 112 patients who underwent RARC with ICUD were included with a minimum follow-up of 12 months. Intracorporeal Perugia ileal neobladder was performed in 74.1% of cases while ileal conduit was performed in 25.9%. The mean operative time, estimated intraoperative blood loss, and LOS were 289.1 ± 59.7 min, 390.6 ± 186.2 ml, and 17.5 ± 9.8 days, respectively. Early minor and major complications accounted for 26.7% and 10.8%, respectively. Overall late complications were 40.2%. The late most common complications were hydronephrosis (11.6%) and urinary tract infections (20.5%). Stone reservoir formation occurred in 2.7% of patients. Major complications occurred in 5.4%. In the sub-analysis, the mean operative time and the estimated blood loss improved significantly from the first 56 procedures to the last ones. Conclusion RARC with ICUD performed by mechanical stapler is a safe and effective technique. Stapled Y-shaped neobladder did not increase the complication rate.
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Lemiński A, Michalski W, Masojć B, Kaczmarek K, Małkiewicz B, Kienitz J, Zawisza-Lemińska B, Falco M, Słojewski M. Combined Modality Bladder-Sparing Therapy for Muscle-Invasive Bladder Cancer: How (Should) We Do It? A Narrative Review. J Clin Med 2023; 12:1560. [PMID: 36836093 PMCID: PMC9960746 DOI: 10.3390/jcm12041560] [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: 01/07/2023] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Organ-sparing combined-modality treatment for muscle-invasive bladder cancer remains underutilized despite high-quality evidence regarding its efficacy, safety, and preservation of quality of life. It may be offered to patients unwilling to undergo radical cystectomy, as well as those unfit for neoadjuvant chemotherapy and surgery. The treatment plan should be tailored to each patient's characteristics, with more intensive protocols offered to patients who are fit for surgery but opt for organ-sparing. After a thorough, debulking transurethral resection of the tumor and neoadjuvant chemotherapy, the response evaluation should trigger further management with either chemoradiation or early cystectomy in non-responders. A hypofractionated, continuous radiotherapy regimen of 55 Gy in 20 fractions with concurrent radiosensitizing chemotherapy with gemcitabine, cisplatin, or 5-fluorouracil and mitomycin C is currently preferred based on clinical trials. The response should be evaluated with repeated transurethral resections of the tumor bed and abdominopelvic-computed tomography after chemoradiation, with quarterly assessments during the first year. Salvage cystectomy should be offered to patients fit for surgery who failed to respond to treatment or developed a muscle-invasive recurrence. Non-muscle-invasive bladder recurrences and upper tract tumors should be treated in line with guidelines for respective primary tumors. Multiparametric magnetic resonance can be used for tumor staging and response monitoring, as it may distinguish disease recurrence from treatment-induced inflammation and fibrosis.
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Affiliation(s)
- Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Wojciech Michalski
- Department of Urological Cancer, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Roentgena 5, 02-781 Warsaw, Poland
| | - Bartłomiej Masojć
- Department of Radiotherapy, West-Pomeranian Oncology Center, 71-730 Szczecin, Poland
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Jakub Kienitz
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | | | - Michał Falco
- Department of Radiotherapy, West-Pomeranian Oncology Center, 71-730 Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
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Brummelhuis ISG, Crezee J, Witjes JA. Evaluation of thermal dose effect in radiofrequency-induced hyperthermia with intravesical chemotherapy for nonmuscle invasive bladder cancer. Int J Hyperthermia 2023; 40:2157498. [PMID: 36755433 DOI: 10.1080/02656736.2022.2157498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
PURPOSE In nonmuscle invasive bladder cancer (NMIBC) patients who fail standard intravesical treatment and are unfit or unwilling to undergo a radical cystectomy, radiofrequency (RF)-induced hyperthermia combined with intravesical chemotherapy (RF-CHT) has shown promising results. We studied whether higher thermal dose improves clinical NMIBC outcome. METHODS AND MATERIALS The cohort comprised 108 patients who started with RF-CHT between November 2013 and December 2019. Patients received intravesical mitomycin-C or epirubicin. Bladder hyperthermia was accomplished with an intravesical 915 MHz RF device guided by intravesical thermometry. We assessed the association between thermal dose parameters (including median temperature and Cumulative Equivalent Minutes of T50 at 43 °C [CEM43T50]) and complete response (CR) at six months for patients with (concomitant) carcinoma in situ (CIS), and recurrence-free survival (RFS) for patients with papillary disease. RESULTS Median temperature and CEM43T50 per treatment were 40.9 (IQR 40.8-41.1) °C and 3.1 (IQR 0.9-2.4) minutes, respectively. Analyses showed no association between any thermal dose parameter and CR or RFS (p > 0.05). Less bladder spasms during treatment sessions was associated with increased median temperature and CEM43T50 (adjusted OR 0.01 and 0.34, both p < 0.001). CONCLUSIONS No significant association between thermal dose and NMIBC outcome was found. Possibly thermal dose effect in patients of the current cohort exceeds a certain threshold value. On the other hand, occurrence of bladder spasms had a thermal dose limiting effect. We advise to treat patients with temperatures >40.5 °C for at least 45 min while respecting individual tolerability, including occurrence of bladder spasms.
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Affiliation(s)
- Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes Crezee
- Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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The Impact of Facility Surgical Caseload Volumes on Survival Outcomes in Patients Undergoing Radical Cystectomy. Cancers (Basel) 2022; 14:cancers14235984. [PMID: 36497466 PMCID: PMC9735798 DOI: 10.3390/cancers14235984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
The role of surgical experience and its impact on the survival requires further investigation. A cohort of patients undergoing radical cystectomy or anterior pelvic exenteration for localized bladder cancer between 2006 and 2013 at 1143 facilities across the United States was identified using the National Cancer Database and analyzed. Using overall survival (OS) as the primary outcome, the relationship between facility annual caseload (FAC) and facility annual surgical caseload (FASC) for those undergoing curative surgery was examined. Four volume groups (VG) depending on caseload using both FAC and FASC were defined. These included VG1: below 50th percentile, VG2: 50th−74th percentile, VG3: 75th−89th percentile, and VG4: 90th and above. Between 2006 and 2013, 27,272 patients underwent surgery for localized bladder cancer. The median OS was 59.66 months (95% CI: 57.79−61.77). OS improved significantly as caseload increased. The unadjusted median OS difference between VG1 and VG4 was 15.35 months (64.3 vs. 48.95 months, HR 1.19 95% CI: 1.13−1.25, p < 0.001) for FAC. This figure was 19.84 months (66.89 vs. 47.05 months, HR 1.25 95% CI: 1.18−1.32, p < 0.0001) for FASC. This analysis revealed a significant and clinically important survival advantage for curative bladder cancer surgery at highly experienced centers.
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Neuzillet Y, Audenet F, Loriot Y, Allory Y, Masson-Lecomte A, Leon P, Pradère B, Seisen T, Traxer O, Xylinas E, Roumiguié M, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Muscle-Invasive Bladder Cancer (MIBC). Prog Urol 2022; 32:1141-1163. [PMID: 36400480 DOI: 10.1016/j.purol.2022.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update the CCAFU recommendations for the management of muscle invasive bladder carcinoma (MIBC). METHODS A systematic review (Medline) of the literature from 2020 to 2022 was performed taking account of the diagnosis, treatment options and surveillance of NMIBC and MIBC, while evaluating the references with their levels of evidence. RESULTS MIBC is diagnosed after the most complete tumour resection possible. MIBC grading is based on CTU along with chest CT. Multiparametric pelvic MRI could be an alternative. Cystectomy with extensive lymphadenectomy is the gold standard treatment for non-metastatic MIBC. It should be preceded by platinum-based neoadjuvant chemotherapy in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed in men and women in the absence of contraindications and when the urethral resection is negative on extemporaneous examination. Otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. Inclusion of all patients in an ERAS (Enhanced Recovery After Surgery) protocol is recommended. For metastatic MIBC, first line treatment with platinum-based chemotherapy (GC or MVAC) is recommended, if general health (PS>1) and renal function (clearance>60mL/min) so allow (only 50% of the cases). Pembrolizumab immunotherapy has demonstrated an overall survival benefit in second-line treatment. CONCLUSION Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and decision-making concerning MIBC treatment.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, université Paris Saclay, Suresnes, France.
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP Centre, université Paris Cité, Paris, France
| | - Y Loriot
- Service d'oncologie médicale, institut Gustave Roussy, Villejuif, France
| | - Y Allory
- Service d'anatomopathologie, institut Curie, université Paris Saclay, Saint-Cloud, France
| | - A Masson-Lecomte
- Service d'urologie, hôpital Saint-Louis, AP-HP, université Paris Cité, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - T Seisen
- Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - O Traxer
- Sorbonne université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, urologie, hôpital Tenon, 75020 Paris, France
| | - E Xylinas
- Service d'urologie, hôpital Bichat-Claude Bernard, AP-HP, université Paris Cité, Paris, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, université de Toulouse, Toulouse, France
| | - M Roupret
- Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
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Daneshmand S, Brummelhuis IS, Pohar KS, Steinberg GD, Aron M, Cutie CJ, Keegan KA, Maffeo JC, Reynolds DL, Raybold B, Chau A, Witjes JA. The safety, tolerability, and efficacy of a neoadjuvant gemcitabine intravesical drug delivery system (TAR-200) in muscle-invasive bladder cancer patients: a phase I trial. Urol Oncol 2022; 40:344.e1-344.e9. [DOI: 10.1016/j.urolonc.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
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Kool R, Yanev I, Hijal T, Vanhuyse M, Cury FL, Souhami L, Kassouf W, Dragomir A. Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: A Canadian cost-effectiveness analysis. Can Urol Assoc J 2022; 16:189-198. [PMID: 35099381 PMCID: PMC9245963 DOI: 10.5489/cuaj.7430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Trimodal therapy (TMT) is a suitable alternative to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for patients with muscle-invasive bladder cancer (MIBC). In this study, we conducted a cost-effectiveness evaluation of RC±NAC vs. TMT for MIBC in the universal and publicly funded Canadian healthcare system. METHODS We developed a Markov model with Monte-Carlo microsimulations. Rates and probabilities of transitioning within different health states (e.g., cure, locoregional recurrence, distant metastasis, death) were input in the model after a scoped literature review. Two main scenarios were considered: 1) academic center; and 2) populational-level. Results were reported in life-years gained (LYG), quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER). A sensitivity analysis was performed. RESULTS A total of 20 000 patients were simulated. For the academic center model, TMT was associated with increased effectiveness (both in LYG and QALY) at a higher cost compared to RC±NAC at five and 10 years. This resulted in an ICER of $19 746/QALY per patient undergoing the TMT strategy at 10 years of followup. For the populational-level model, RC±NAC was associated with higher effectiveness at 10 years, with an ICER of $3319/QALY per patient. This study was limited by heterogeneity within the studies used to build the model. CONCLUSIONS In this study, TMT performed in academic centers was cost-effective compared to RC±NAC, with higher effectiveness at a higher cost. On the other hand, RC±NAC was considered cost-effective compared to TMT at the populational-level. Further studies are needed to confirm these results.
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Affiliation(s)
- Ronald Kool
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Ivan Yanev
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Marie Vanhuyse
- Division of Medical Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Fabio L. Cury
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Alice Dragomir
- Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada
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12
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Wu J, Xie RY, Cao CZ, Shang BQ, Shi HZ, Shou JZ. Disease Management of Clinical Complete Responders to Neoadjuvant Chemotherapy of Muscle-Invasive Bladder Cancer: A Review of Literature. Front Oncol 2022; 12:816444. [PMID: 35494010 PMCID: PMC9043546 DOI: 10.3389/fonc.2022.816444] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Muscle-invasive bladder cancer (MIBC) is an aggressive disease requiring active management. Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is considered the standard treatment paradigm for MIBC patients, which could result in significant perioperative mortality and morbidity, as well as the significant alteration of the quality of life (QOL). Notably, multimodal bladder-preserving treatment strategies have been recommended for highly selected patients. Pathologic complete response (pCR) after NAC is a powerful prognostic indicator of survival for patients with MIBC. Clinical complete response (cCR) is then introduced as a complementary endpoint for pCR to assess disease status preoperatively. Bladder preservation strategy for patients who achieve cCR following NAC is emerging as a new treatment concept. However, the efficiency of the conservative strategy remains controversial. In this state-of-the-art review, we discuss the advantages and limitations of cCR and the feasibility and safety of bladder preservation strategy in highly selected MIBC patients who achieve cCR following NAC. We conclude that a conservative strategy can be considered a reasonable alternative to RC in carefully selected cCR MIBC patients, leading to acceptable oncological outcomes.
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Affiliation(s)
- Jie Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui-Yang Xie
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuan-Zhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing-Qing Shang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Zhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Zhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Li Y, Youssef SF, Buanz ABM. Intravesical combination therapies for non-muscle invasive bladder cancer: Recent advances and future directions. Eur J Pharmacol 2022; 926:175024. [DOI: 10.1016/j.ejphar.2022.175024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
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14
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Lemiński A, Kaczmarek K, Gołąb A, Kotfis K, Skonieczna-Żydecka K, Słojewski M. Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study. Clin Interv Aging 2022; 17:255-263. [PMID: 35299721 PMCID: PMC8922233 DOI: 10.2147/cia.s352890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Muscle invasive bladder cancer (MIBC) is a common malignancy amongst elderly. Increasing life expectancy, prevalence of smoking, lifelong exposure to environmental pollutants and immunosenescence contribute to growing number of cases. Traditionally, radical cystectomy (RC) with pelvic lymph node dissection (PLND) constituted the mainstay of treatment for MIBC, but despite proven feasibility in elderly population, it has been associated with significant burden of morbidity, mortality, and complications. Study Objective We aimed to re-evaluate the safety and efficacy of RC amongst the elderly patients with MIBC. Material and Methods This single-center, retrospective, observational comparative study was conducted among 568 patients who underwent RC due to MIBC between 2003 and 2021. We evaluated the influence of chronological age (<70 vs ≥70 years) on clinical, demographic, and pathological variables related to MIBC and RC. Results Elderly patients had similar clinical and pathological features of disease compared to their younger counterparts; nonetheless, they more often received simplified urinary diversion, ie ureterostomy (60.25% vs 39.33%, p<0.001) and had no PLND (15.76% vs 8.5%, p=0.01) during RC. Furthermore, more elderly patients were treated for secondary MIBCs and fewer had history of smoking. Severe complication and 90-day mortality rates were comparable between groups; however, the elderly had significantly higher all-cause mortality at one year post RC (46.67% vs 33.25%, p=0.003). On multivariate analysis, one-year mortality risk was independently associated with elderly age (HR=2.119, 95% CI: 1.227–3.660, p=0.007), rural residency (HR=1.760, 95% CI: 1.043–2.968, p=0.034), extravesical extension of tumor (HR=2.109, 95% CI: 1.155–3.850, p=0.015), lymph node metastasis (HR=2.268, 95% CI: 1.290–3.987, p=0.004) and omission of PLND (HR=6.064, 95% CI: 2.926–12.568, p<0.001). Conclusion Radical cystectomy in elderly patients is associated with significant one-year mortality. Our study emphasizes the unmet need for considerate planning of treatment for MIBC in potentially vulnerable groups of elderly patients. Efforts are needed to reliably identify those unlikely to benefit from surgery and facilitate patient-centered choice of alternative therapies.
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Affiliation(s)
- Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
- Correspondence: Artur Lemiński, Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, Szczecin, 70-111, Poland, Tel +48-91-466-1101, Fax +48-91-466-1100, Email
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
- Katarzyna Kotfis, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, Szczecin, 70-111, Poland, Tel +48-91-466-1146, Fax +48-91-466-1144, Email
| | | | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
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15
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Hanusek K, Poletajew S, Kryst P, Piekiełko-Witkowska A, Bogusławska J. piRNAs and PIWI Proteins as Diagnostic and Prognostic Markers of Genitourinary Cancers. Biomolecules 2022; 12:biom12020186. [PMID: 35204687 PMCID: PMC8869487 DOI: 10.3390/biom12020186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/30/2022] Open
Abstract
piRNAs (PIWI-interacting RNAs) are small non-coding RNAs capable of regulation of transposon and gene expression. piRNAs utilise multiple mechanisms to affect gene expression, which makes them potentially more powerful regulators than microRNAs. The mechanisms by which piRNAs regulate transposon and gene expression include DNA methylation, histone modifications, and mRNA degradation. Genitourinary cancers (GC) are a large group of neoplasms that differ by their incidence, clinical course, biology, and prognosis for patients. Regardless of the GC type, metastatic disease remains a key therapeutic challenge, largely affecting patients’ survival rates. Recent studies indicate that piRNAs could serve as potentially useful biomarkers allowing for early cancer detection and therapeutic interventions at the stage of non-advanced tumour, improving patient’s outcomes. Furthermore, studies in prostate cancer show that piRNAs contribute to cancer progression by affecting key oncogenic pathways such as PI3K/AKT. Here, we discuss recent findings on biogenesis, mechanisms of action and the role of piRNAs and the associated PIWI proteins in GC. We also present tools that may be useful for studies on the functioning of piRNAs in cancers.
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Affiliation(s)
- Karolina Hanusek
- Centre of Postgraduate Medical Education, Department of Biochemistry and Molecular Biology, 01-813 Warsaw, Poland;
| | - Sławomir Poletajew
- Centre of Postgraduate Medical Education, II Department of Urology, 01-813 Warsaw, Poland; (S.P.); (P.K.)
| | - Piotr Kryst
- Centre of Postgraduate Medical Education, II Department of Urology, 01-813 Warsaw, Poland; (S.P.); (P.K.)
| | - Agnieszka Piekiełko-Witkowska
- Centre of Postgraduate Medical Education, Department of Biochemistry and Molecular Biology, 01-813 Warsaw, Poland;
- Correspondence: (A.P.-W.); (J.B.)
| | - Joanna Bogusławska
- Centre of Postgraduate Medical Education, Department of Biochemistry and Molecular Biology, 01-813 Warsaw, Poland;
- Correspondence: (A.P.-W.); (J.B.)
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16
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Brummelhuis ISG, Simons M, Lindner LH, Kort S, de Jong S, Hossann M, Witjes JA, Oosterwijk E. DPPG 2-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo. Int J Hyperthermia 2021; 38:1415-1424. [PMID: 34581259 DOI: 10.1080/02656736.2021.1983038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Recommended treatments for muscle-invasive bladder cancer (MIBC) come with considerable morbidity. Hyperthermia (HT) triggered drug release from phosphatidylglycerol-based thermosensitive liposomes (DPPG2-TSL) might prevent surgical bladder removal and toxicity from systemic chemotherapy. We aimed to assess the efficacy of DPPG2-TSL with HT in a syngeneic orthotopic rat urothelial carcinoma model. METHODS A total of 191 female Fischer F344 rats were used. Bladder tumors were initiated by inoculation of AY-27 cells and tumor-bearing rats were selected with cystoscopy and semi-randomized over treatment groups. On days 5 and 8, animals were treated with DOX in different treatment modalities: intravenous (iv) DPPG2-TSL-DOX with HT, iv free DOX without HT, intravesical DOX without HT, intravesical DOX with HT or no treatment (control group), respectively. Animals were euthanized on day 14 and complete tumor response was assessed by histopathological evaluation. RESULTS Iv DPPG2-TSL-DOX + HT resulted in a favorable rate of animals with complete tumor response (70%), compared to iv free DOX (18%, p = .02), no treatment (0%, p = .001), and intravesical DOX with (43%, p = .35) or without HT (50%, p = .41). All rats receiving intravesical DOX with HT and 24% of rats treated with DPPG2-TSL-DOX containing the same DOX dose with HT had to be euthanized before day 14 because of substantial bodyweight loss, which was associated with dilated ureters urine retention in a few rats. CONCLUSION Treatment with DPPG2-TSL-DOX combined with intravesical HT outperformed systemic and intravesical DOX in vivo. There might be a role for DPPG2-TSL encapsulating chemotherapeutics in the treatment of MIBC in the future.
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Affiliation(s)
- Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars H Lindner
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Simone Kort
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Sytse de Jong
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Arnold CR, Lindner AK, Schachtner G, Tulchiner G, Tulchiner N, Mangesius J, Maffei M, Horninger W, Kouvaiou O, Lukas P, Ganswindt U, Pichler R, Skvortsov S. Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer-a valid option for cisplatin-unfit patients? Strahlenther Onkol 2021; 198:25-32. [PMID: 34414475 PMCID: PMC8760228 DOI: 10.1007/s00066-021-01837-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Abstract
Purpose Treatment of muscle-invasive bladder cancer (MIBC) remains challenging, especially for elderly and/or comorbid patients. Patients who are unfit for or refuse surgery should receive bladder-preserving multimodality treatment (BPMT), consisting of transurethral resection of the bladder tumor (TURB) followed by combined chemoradiotherapy (CRT). We aimed to investigate the effectiveness of vinorelbine, a chemotherapeutic agent not routinely used for MIBC, in patients referred to CRT who are unfit for standard chemotherapy and would thus rely solely on radiotherapy (RT). Methods We retrospectively analyzed 52 consecutive patients with MIBC who received standard CRT with cisplatin (n = 14), CRT with vinorelbine (n = 26), or RT alone (n = 12). Primary endpoints were median overall survival (OS) and median cancer-specific survival (CSS). Secondary endpoints were median local control (LC), median distant control (DC), and OS, CSS, LC, and DC after 1, 2, and 3 years, respectively. Results Median OS and CSS were significantly higher for patients who received vinorelbine as compared to RT alone (OS 8 vs. 22 months, p = 0.003; CSS 11 months vs. not reached, p = 0.001). Median LC and DC did not differ significantly between groups. Vinorelbine was well tolerated with no reported side effects >grade II. Conclusion Our results suggest that CRT with vinorelbine is well tolerated and superior to RT alone in terms of OS and CSS. Therefore, this treatment regime might constitute a new treatment option for patients with MIBC who are unfit for or refuse surgery or standard chemotherapy. This study encourages a randomized controlled trial to compare this new regime to current standard therapies.
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Affiliation(s)
- C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - A K Lindner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - G Schachtner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - G Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - J Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - M Maffei
- Department of Radiation Oncology, General Hospital Bolzano, Lorenz Böhler Straße 5, 39100, Bolzano, Italy
| | - W Horninger
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - O Kouvaiou
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - P Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - U Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - R Pichler
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - S Skvortsov
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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18
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Gul ZG, Katims AB, Winoker JS, Wiklund P, Waingankar N, Mehrazin R. Robotic assisted radical cystectomy versus open radical cystectomy: a review of what we do and don't know. Transl Androl Urol 2021; 10:2209-2215. [PMID: 34159104 PMCID: PMC8185680 DOI: 10.21037/tau.2019.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Radical cystectomy (RC) is the gold standard treatment for muscle-invasive and high-risk, noninvasive bladder cancer. Since 2003, robot-assisted radical cystectomy (RARC) has been gaining popularity. Metanalyses show that the primary advantage of RARC is less blood loss and the primary advantage of open radical cystectomy (ORC) is shorter operative times. There do not appear to be significant differences in complications, cancer-related outcomes or survival between the two approaches. Cost analyses comparing RARC and ORC are complicated by the often-ill-defined distinction between the cost to the hospital versus the cost to payors. However, it is likely that for both hospitals and payors, RARC is cost effective at high-volume centers. It is feasible that in the future, increased experience with RARC will lead to improved outcomes and justify the use of RARC over ORC.
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Affiliation(s)
- Zeynep G Gul
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew B Katims
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Au D, Lee EK, Popoola TO, Parker WP, Onge JMS, Ellis SD. Factors associated with utilization of neoadjuvant chemotherapy in charlson comorbidity zero non-metastatic muscle-invasive bladder cancer patients. Int Braz J Urol 2021; 47:803-818. [PMID: 33848073 PMCID: PMC8321501 DOI: 10.1590/s1677-5538.ibju.2020.0594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Guideline-based best practice treatment for muscle invasive bladder cancer (MIBC) involves neoadjuvant chemotherapy followed by radical cystectomy (NACRC). Prior studies have shown that a minority of patients receive NACRC and older age and renal function are drivers of non-receipt of NACRC. This study investigates treatment rates and factors associated with not receiving NACRC in MIBC patients with lower comorbidity status most likely to be candidates for NACRC. Materials and Methods: Retrospective United States National Cancer Database analysis from 2006 to 2015 of MIBC patients with Charlson comorbidity index (CCI) of zero. Analysis of NACRC treatment trends in higher CCI patients was also performed. Results: 15.561 MIBC patients met inclusion criteria. 1.507 (9.7%) received NACRC within 9 months of diagnosis. NACRC increased over time (15.0% in 2015 compared to 3.6% in 2006). Higher NACRC was noted in females, cT3 or cT4 cancer, later year of diagnosis, and academic facility treatment. Lower utilization was noted for blacks and NACRC decreased with increasing age and CCI. Only 16.9% of patients aged 23-62 in the lowest age quartile with muscle invasive bladder cancer and CCI of 0 received NACRC. Conclusions: Although utilization is increasing, receipt of NACRC remains low even in populations most likely to be candidates. Further study should continue to elucidate barriers to utilization of NACRC.
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Affiliation(s)
- Daniel Au
- Department of Urology, University of Kansas Health System, Kansas City, KS, United States
| | - Eugene K Lee
- Department of Urology, University of Kansas Health System, Kansas City, KS, United States
| | - Taiye O Popoola
- Department of Population, Health University of Kansas Health System, Kansas City, KS, United States
| | - William P Parker
- Department of Urology, University of Kansas Health System, Kansas City, KS, United States
| | - Jarron M Saint Onge
- Department of Population, Health University of Kansas Health System, Kansas City, KS, United States
| | - Shellie D Ellis
- Department of Population, Health University of Kansas Health System, Kansas City, KS, United States
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Abstract
The cornerstone for diagnosis and treatment of bladder and upper tract urothelial carcinoma involves surgery. Transurethral resection of bladder tumors forms the basis of further management. Radical cystectomy for invasive bladder carcinoma provides good oncologic outcomes. However, it can be a morbid procedure, and advances such as minimally invasive surgery and early recovery after surgery need to be incorporated into routine practice. Diagnostic ureteroscopy for upper tract carcinoma is needed in cases of doubt after cytology and imaging studies. Low-risk cancers can be managed with conservative endoscopic surgery without compromising oncological outcomes; however, high-risk disease necessitates radical nephroureterectomy.
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21
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Challapalli A, Masson S, White P, Dailami N, Pearson S, Rowe E, Koupparis A, Oxley J, Abdelaziz A, Ash-Miles J, Bravo A, Foulstone E, Perks C, Holly J, Persad R, Bahl A. A Single-arm Phase II Trial of Neoadjuvant Cabazitaxel and Cisplatin Chemotherapy for Muscle-Invasive Transitional Cell Carcinoma of the Urinary Bladder. Clin Genitourin Cancer 2021; 19:325-332. [PMID: 33727028 DOI: 10.1016/j.clgc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel. METHODS A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p0 = 0.35 and p1 = 0.60, α = 0.05). RESULTS Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one- third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse (P = .001, log-rank) in patients who did not achieve an objective response. CONCLUSION Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%-26%). These results warrant further evaluation in a phase III study.
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Affiliation(s)
| | - Susan Masson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Paul White
- Department of Statistics, University of the West of England, Bristol, UK
| | - Narges Dailami
- Department of Statistics, University of the West of England, Bristol, UK
| | - Sylvia Pearson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Jon Oxley
- Department of Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Abdelaziz
- Department of Oncology, Ain Shams University Hospitals, Egypt
| | | | - Alicia Bravo
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Emily Foulstone
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Claire Perks
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeff Holly
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Raj Persad
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK.
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22
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Joensen UN, Maibom SL, Poulsen AM. Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations. Semin Oncol Nurs 2021; 37:151104. [PMID: 33541734 DOI: 10.1016/j.soncn.2020.151104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To provide a narrative overview of contemporary surgical management of muscle-invasive bladder cancer with focus on radical cystectomy and urinary tract reconstruction. DATA SOURCES International guidelines and a search for articles in PubMed, Medline, and Cochrane Database for single and collaborative studies on surgical management of muscle-invasive bladder cancer. CONCLUSION Patients diagnosed with muscle invasive bladder cancer often have complex treatment and care needs. For those who undergo radical cystectomy as the curative treatment, there is a considerable risk of general complications after major surgery and short- and long-term complications specific to reconstruction of the urinary tract after radical cystectomy. Contemporary care focuses on perioperative optimization to lower rates of major complications, enhanced recovery protocols, and focus on rehabilitation and cancer survivorship. IMPLICATIONS FOR NURSING PRACTICE Nurses are integral members of the multidisciplinary team around patients undergoing surgery for muscle-invasive bladder cancer, and are in a position to coordinate pathways for these patients who often have complex care needs because of preexisting comorbidity and limited personal resources that impede recovery after major surgery and cancer survivorship.
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Affiliation(s)
- Ulla Nordström Joensen
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sophia Liff Maibom
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Brummelhuis ISG, Wimper Y, Witjes-van Os HGJM, Arends TJH, van der Heijden AG, Witjes JA. Long-Term Experience with Radiofrequency-Induced Hyperthermia Combined with Intravesical Chemotherapy for Non-Muscle Invasive Bladder Cancer. Cancers (Basel) 2021; 13:cancers13030377. [PMID: 33498535 PMCID: PMC7864165 DOI: 10.3390/cancers13030377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The recurrence rate of non-muscle invasive bladder cancer (NMIBC) is high, despite intravesical treatments. Importantly, patients are frequently unfit or unwilling to undergo a recommended radical cystectomy when standard intravesical treatments fail, due to the substantial risk of morbidity and mortality. For these patients, radiofrequency-induced hyperthermia combined with intravesical chemotherapy (RF-CHT) has shown promising results. We aim to determine treatment outcomes and assess the effect of (ablative) dose. METHODS 299 intensively pretreated patients treated with RF-CHT were included in safety analysis. Of these, 274 patients who fulfilled induction treatments were included in efficacy analysis. Six-month complete response (CR) and durable response were reported for (concomitant) carcinoma in situ (CIS) patients and recurrence-free survival (RFS) for papillary patients. RESULTS For CIS, six-month CR-rate was 56.0%; and durable response rates were 79.7%, 66.5%, and 40.3% at one-, two- and five-year, respectively. RFS rates for papillary patients were 77.9%, 57.5%, and 37.2%, respectively. Patients treated with ablative dose are less likely to develop recurrence (adjusted Hazard Ratio 0.54, p = 0.01), compared to adjuvant dose. CONCLUSIONS RF-CHT is effective in NMIBC patients in whom standard intravesical treatments have failed and should be considered in patients who are unwilling or unfit to undergo radical cystectomy. Patients with CIS or residual papillary tumor at baseline benefit from ablative dose.
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Affiliation(s)
- Iris S. G. Brummelhuis
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
- Correspondence: ; Tel.: +31-243619515
| | - Yvonne Wimper
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
| | - Hilde G. J. M. Witjes-van Os
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
| | - Tom J. H. Arends
- Department of Urology, Meander Medical Centre Amersfoort, 3813 TZ Amersfoort, The Netherlands;
| | - Antoine G. van der Heijden
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (Y.W.); (H.G.J.M.W.-v.O.); (A.G.v.d.H.); (J.A.W.)
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Maisch P, Lunger L, Düwel C, Schmid SC, Horn T, Gschwend JE, Sauter A, Heck MM. Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer. Urol Oncol 2021; 39:368.e11-368.e17. [PMID: 33431328 DOI: 10.1016/j.urolonc.2020.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radical cystectomy (Cx) is the standard of care for muscle-invasive bladder cancer (BCa). In locally advanced pT4 BCa the oncologic outcome is inexplicit but Cx may be necessary for palliation. OBJECTIVES The aim of this retrospective study was to evaluate the outcomes of Cx performed in patients with locally advanced pT4 BCa and to identify patient subgroups with improved outcome. METHODS Between 2008 and 2017, we identified 76 of 905 patients who underwent Cx for pT4 BCa at a single tertiary referral center. The physical patients' status was estimated according to the American Society of Anesthesiologists (ASA) classification. For the classification of postoperative complication rates, the Clavien-Dindo grading was used. Time-to-event variables with log-rank statistics were calculated with the use of the Kaplan-Meier method. RESULTS Median age was 74 years (range 42-90). Preoperatively, the physical status was estimated poor in 40 (52%) patients (ASA-score of ≥3). Overall, 19 (25%) patients had pT4b BCa, 41 (54%) patients were lymph node positive (c/pN+) and 14 (18%) patients had distant metastases (c/pM+). Within 30 and 90 days after surgery, 21% and 30% of the patients, respectively, developed severe complications (Clavien-Dindo grade ≥3). Overall, 30- and 90-day mortality rates were 9% and 11%, respectively. Moreover, 86% and 75% of patients who died within 30 and 90 days after surgery, respectively, had an ASA-score ≥3. At a median postoperative follow-up of 8 months (range 0-85), 53 (70%) patients have died. During the follow-up period, 46% of the patients died due to progressive disease, 16% died of a noncancer-specific cause, and for 8% of the patients, the reason remains unknown. Median overall survival (OS) and cancer-specific survival were 13.0 and 16.0 months, respectively. In subgroup analyses ASA-score ≥3 and hemoglobin <11.7 g/dl was significantly associated with poor OS. No statistically significant differences were detected between subgroups. CONCLUSION Cx performed in patients with locally advanced pT4 BCa is associated with an increased mortality rate within 90 days postoperatively. Our study revealed that the ASA-score is a relevant and easily available tool to rate the patient´s condition and estimate postoperative outcome.
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Affiliation(s)
- Phillipp Maisch
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany.
| | - Lukas Lunger
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Sebastian C Schmid
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Thomas Horn
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Andreas Sauter
- Department of Radiology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Matthias M Heck
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
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van Valenberg FJP, Brummelhuis ISG, Lindner LH, Kuhnle F, Wedmann B, Schweizer P, Hossann M, Witjes JA, Oosterwijk E. DPPG 2-Based Thermosensitive Liposomes with Encapsulated Doxorubicin Combined with Hyperthermia Lead to Higher Doxorubicin Concentrations in the Bladder Compared to Conventional Application in Pigs: A Rationale for the Treatment of Muscle-Invasive Bladder Cancer. Int J Nanomedicine 2021; 16:75-88. [PMID: 33447028 PMCID: PMC7802347 DOI: 10.2147/ijn.s280034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Current treatment options for muscle-invasive bladder cancer (MIBC) are associated with substantial morbidity. Local release of doxorubicin (DOX) from phosphatidyldiglycerol-based thermosensitive liposomes (DPPG2-TSL-DOX) potentiated by hyperthermia (HT) in the bladder wall may result in bladder sparing without toxicity of systemic chemotherapy. We investigated whether this approach, compared to conventional DOX application, increases DOX concentrations in the bladder wall while limiting DOX in essential organs. Materials and Methods Twenty-one pigs were anaesthetized, and a urinary catheter equipped with a radiofrequency-emitting antenna for HT (60 minutes) was placed. Experimental groups consisted of iv low or full dose (20 or 60 mg/m2) DPPG2-TSL-DOX with/without HT, iv low dose (20 mg/m2) free DOX with HT, and full dose (50 mg/50 mL) intravesical DOX with/without HT. After the procedure, animals were immediately sacrificed. HPLC was used to measure DOX levels in the bladder, essential organs and serum, and fluorescence microscopy to evaluate DOX distribution in the bladder wall. Results Iv DPPG2-TSL-DOX with HT resulted in a significantly higher bladder wall DOX concentration which was more homogeneous distributed, than iv and intravesical free DOX administration with HT. Specifically in the detrusor, DPPG2-TSL-DOX with HT led to a >7- and 44-fold higher DOX concentration, compared to iv free DOX with HT and intravesical DOX, respectively. Organ DOX concentrations were significantly lower in heart and kidneys, and similar in liver, spleen and lungs, following iv DPPG2-TSL-DOX with HT, compared to iv free DOX. Intravesical DOX led to the lowest organ DOX concentrations. Conclusion Iv DPPG2-TSL-DOX combined with HT achieved higher DOX concentrations in the bladder wall including the detrusor, compared to conventional iv and intravesical DOX application. In combination with lower DOX accumulation in heart and kidneys, compared to iv free chemotherapy, DPPG2-TSL-DOX with HT has great potential to attain a role as a bladder-sparing treatment for MIBC.
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Affiliation(s)
| | - Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lars H Lindner
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Felix Kuhnle
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Barbara Wedmann
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | | | | | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
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Korkes F, Cunha FTS, Nascimento MP, Rodrigues AFS, Baccaglini W, Glina S. Mortality after radical cystectomy is strongly related to the institution's volume of surgeries. EINSTEIN-SAO PAULO 2020; 18:eAO5628. [PMID: 33295426 PMCID: PMC7690935 DOI: 10.31744/einstein_journal/2020ao5628] [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: 02/20/2020] [Accepted: 06/24/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.
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Affiliation(s)
| | | | | | | | | | - Sidney Glina
- Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Posada Calderon L, Al Hussein Al Awamlh B, Shoag J, Patel N, Nicolas JD, Scherr DS. The role of surgical experience in patient selection, surgical quality, and outcomes in robot-assisted radical cystectomy. Urol Oncol 2020; 39:6-12. [PMID: 33127299 DOI: 10.1016/j.urolonc.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Robot-assisted radical cystectomy (RARC) remains one of the most complex urological procedures. Due to regionalization of bladder cancer care, there is likely an imbalance in experience among urologists performing RARC. We sought to describe changes in patient selection, surgical quality surrogates and rates of complications in relation to surgical experience. METHODS We retrospectively reviewed 409 consecutive patients with bladder cancer who underwent RARC between 2006 and 2017 by a single surgeon. The cohort was divided into 4 quartiles (Q1-Q4) according to surgical experience, based on the chronologic order at which RARC was performed. Baseline, perioperative and pathologic characteristics of patients were compared among the 4 groups. 30-day and 90-day complications were assessed using the Clavien-Dindo system. The association between surgical experience (quartile) and complications was assessed using multivariable logistic regression analyses. RESULTS Median age (interquartile range [IQR] from 70-73 years), body mass index (IQR from 25 to 27 kg/m2) and preoperative glomerular filtration rate (IQR from 59 to 65 ml/min) were similar among all quartiles (all P > 0.05). Patients in Q4 had higher rates of previous abdominopelvic surgery (46.1% vs. 30.4%, P = 0.031) and American Society of Anesthesiologists score of 3 to 4 (72.3% vs. 47.1%, P = 0.003) compared to patients in Q1. Patients who underwent RARC in Q4 compared to Q1, had less estimated blood loss (250 ml vs. 350 ml, P < 0.001), shorter operative time (346 vs. 360 minutes, P < 0.001), and higher lymph node yield (22 vs. 17 nodes, P < 0.001). The 30-day and 90-day complication rates were 53% and 62%, respectively. Thirty-day complication rates were similar among all 4 quartiles (P > 0.05), but higher among patients in Q4 compared to Q1 within 90 days (74% vs. 54%, P = 0.01). On multivariable analysis, patients in Q4 were more likely to experience any 90-day complication (OR 2.03, 95%Cl 1.11-3.70) compared to Q1. CONCLUSION Our results show that with surgical experience, more complex cases can be performed while continuing to improve surgical quality. Nonetheless, there appears to be a trade-off between the increase in complexity of cases performed with experience and accepting higher rates of complications.
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Affiliation(s)
- Lina Posada Calderon
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | | | - Jonathan Shoag
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA; Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Neal Patel
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Joseph D Nicolas
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Douglas S Scherr
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
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Marinaro J, Zeymo A, Egan J, Carvalho F, Krasnow R, Stamatakis L, Lynch J, Hwang J, Williams S, Kowalczyk K. Sex and Racial Disparities in the Treatment and Outcomes of Muscle-invasive Bladder Cancer. Urology 2020; 151:154-162. [PMID: 32810481 DOI: 10.1016/j.urology.2020.06.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify racial and sex disparities in the treatment and outcomes of muscle-invasive bladder cancer (MIBC) using a nationwide oncology outcomes database. METHODS Using the National Cancer Database, we identified patients with muscle invasive bladder cancer from 2004 to 2014. Treatments analyzed included no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy ("optimal treatment"), cystectomy plus adjuvant chemotherapy, and chemoradiation. Propensity matching compared mortality outcomes between sexes. Logistic models evaluated predictors of receiving optimal treatment, as well as mortality. RESULTS Forty seven thousand two hundred and twenty nine patients were identified. Most patients were male (73.4%) and underwent cystectomy alone (69.0%). Propensity score matching demonstrated increased 90-day mortality in women vs men (13.0% vs 11.6%, P = .009), despite adjusting for differences in treatments between sexes. Logistic regression models showed no difference in receipt of optimal treatment between sexes (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.83-1.22) although black patients were less likely to receive optimal treatment (OR 0.15, 95% CI 0.05-0.48). Logistic regression models confirmed increased 90-day mortality in female (OR 1.17, CI 1.08-1.27, P < .001) and black (OR 1.29, CI 1.11-1.50, P = .001) patients. Females had a lower overall survival on Cox regression analysis (Hazard Ratio 0.92, 95% CI 0.87-0.97). CONCLUSION While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment.
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Affiliation(s)
- Jessica Marinaro
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC.
| | | | - Jillian Egan
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Filipe Carvalho
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Ross Krasnow
- MedStar Washington Hospital Center, Department of Urology, Washington, DC
| | - Lambros Stamatakis
- MedStar Washington Hospital Center, Department of Urology, Washington, DC
| | - John Lynch
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Jonathan Hwang
- MedStar Washington Hospital Center, Department of Urology, Washington, DC
| | - Stephen Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Keith Kowalczyk
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
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Herrera JC, Ibilibor C, Wang H, Klein GT, Elshabrawy A, Chowdhury WH, Kaushik D, Liss M, Svatek R, Mansour AM. National Trends and Impact of Regionalization of Radical Cystectomy on Survival Outcomes in Patients with Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2020; 18:e762-e770. [PMID: 32641262 DOI: 10.1016/j.clgc.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate national trends and the effect of surgical volume on perioperative mortality and overall survival (OS)in patients undergoing radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). METHODS We investigated the National Cancer Database to identify patients with localized MIBC (cT2a-T4, M0) who underwent RC from 2004 to 2014. Demographics, 30- and 90-day mortality rates, as well as OS were analyzed. Hospitals were stratified into low-, medium-, and high-volume centers according to median number of RCs performed per year. Multivariate logistic regression models were fitted to identify independent predictors of perioperative mortality. Kaplan-Meier survival curves were generated to evaluate OS. Cox proportional hazard modeling was performed to identify independent predictors of OS. RESULTS A total of 24,763 patients with localized MIBC who underwent RC from 2004 to 2014 were included in the study. Overall, most (70.85%) RCs occurred at low-volume hospitals, whereas only 15.83% were performed at high-volume hospitals. Thirty-day mortality rates were 2.87%, 2.19%, and 1.83% (P < .01); and 90-day mortality rates were 8.25%, 6.9%, and 5.9% (P < .01) at low-, medium-, and high-volume hospitals, respectively. Multivariate analyses identified RC volume as an independent predictor of 30- and 90-day mortality. RC in high-volume hospitals was associated with a 35% risk reduction in 30-day mortality (odds ratio 0.65, 95% confidence interval [CI] 0.49-0.85; P < .01), and a 26% risk reduction in 90-day mortality (0.74, 95% CI, 0.63-0.87; P < .01). CONCLUSIONS Treatment at high-volume centers offers improved outcomes and OS benefit. However, in the United States, only 16% of RCs are performed in high-volume hospitals.
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Affiliation(s)
- Juan C Herrera
- Department of Urology, University of Texas Health, San Antonio, TX
| | - Christine Ibilibor
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Hanzhang Wang
- Department of Urology, University of Texas Health, San Antonio, TX
| | | | - Ahmed Elshabrawy
- Department of Urology, University of Texas Health, San Antonio, TX
| | | | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Michael Liss
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Robert Svatek
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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30
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Azam A, Rottenberg G. Multimodality Imaging Findings Postcystectomy: Postoperative Anatomy, Surgical Complications, and Surveillance Imaging. Semin Ultrasound CT MR 2020; 41:392-401. [PMID: 32620229 DOI: 10.1053/j.sult.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Various surgical techniques exist for urinary diversion post cystectomy and each have different imaging features. This diverse range of surgical procedures can make imaging interpretation difficult and so familiarity with the postoperative anatomy is essential. Multiple imaging modalities and techniques are available for the radiologist's assessment including fluoroscopic studies, computed tomography, magnetic resonance, and radionuclide imaging. Knowledge of when each of these modalities is indicated and the typical imaging appearances is essential for early identification of postoperative complications and detection of tumor recurrence. This information enables the radiologist to make an accurate and early diagnosis and subsequently guide the management pathway for these patients.
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Affiliation(s)
- Aishah Azam
- Department of Radiology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Giles Rottenberg
- Department of Radiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
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31
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Leow JJ, Catto JWF, Efstathiou JA, Gore JL, Hussein AA, Shariat SF, Smith AB, Weizer AZ, Wirth M, Witjes JA, Trinh QD. Quality Indicators for Bladder Cancer Services: A Collaborative Review. Eur Urol 2020; 78:43-59. [PMID: 31563501 DOI: 10.1016/j.eururo.2019.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
CONTEXT There is a lack of accepted consensus on what should constitute appropriate quality-of-care indicators for bladder cancer. OBJECTIVE To evaluate the optimal management of bladder cancer and propose quality indicators (QIs). EVIDENCE ACQUISITION A systematic review was performed to identify literature on current optimal management and potential quality indicators for both non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer. A panel of experts was convened to select a recommended list of QIs. EVIDENCE SYNTHESIS For NMIBC, preoperative QIs include tobacco cessation counselling and appropriate imaging before initial transurethral resection of bladder tumour (TURBT). Intraoperative QIs include administration of antibiotics, proper safe conduct of TURBT using a checklist, and performing restaging TURBT with biopsy of the prostatic urethra in appropriate cases. Postoperative QIs include appropriate receipt of perioperative adjuvant therapy, risk-stratified surveillance, and appropriate decision to change therapy when indicated (eg, bacillus Calmette-Guerin [BCG] unresponsive). For MIBC, preoperative QIs include multidisciplinary care, selection for candidates for continent urinary diversion, receipt of neoadjuvant cisplatin-based chemotherapy, time to commencing radical treatment, consideration of trimodal therapy as a bladder-sparing alternative in select patients, preoperative counselling with stoma marking, surgical volume of radical cystectomy, and enhanced recovery after surgery protocols. Intraoperative QIs include adequacy of lymphadenectomy, blood loss, and operative time. Postoperative QIs include prospective standardised monitoring of morbidity and mortality, negative surgical margins for pT2 disease, appropriate surveillance after primary treatment, and adjuvant cisplatin-based chemotherapy in appropriate cases. Participation in clinical trials was highlighted as an important component indicating high quality of care. CONCLUSIONS We propose a set of QIs for both NMIBC and MIBC based on established clinical guidelines and the available literature. Although there is currently a lack of level 1 evidence for the benefit of implementing these QIs, we believe that the measurement of these QIs could aid in the improvement and benchmarking of optimal care for bladder cancer. PATIENT SUMMARY After a systematic review of existing guidelines and literature, a panel of experts has recommended a set of quality indicators that can help providers and patients measure and strive towards optimal outcomes for bladder cancer care.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James W F Catto
- Academic Urology Unit, The University of Sheffield, Sheffield, UK
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ahmed A Hussein
- Department of Urology, Cairo University, Cairo, Egypt; Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Angela B Smith
- Department of Urology, Lineberger Comprehensive Cancer Center, UNC-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - J Alfred Witjes
- Department of Urology, Radboud University, Nijmegen, The Netherlands
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Beano H, He J, Hensel C, Worrilow W, Townsend W, Gaston K, Clark PE, Riggs S. Safety of decreasing ureteral stent duration following radical cystectomy. World J Urol 2020; 39:473-479. [PMID: 32303901 DOI: 10.1007/s00345-020-03191-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/30/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aim to assess the safety of decreasing ureteral stenting duration following Radical Cystectomy with Urinary Diversion (RCUD). MATERIALS AND METHODS We analyzed a prospectively and retrospectively collected dataset for cystectomy patients at our tertiary center. Adult patient who underwent RCUD for malignancy from January 2013 to February 2018 were included. Patients with a history of abdominal/pelvic radiation and continent diversions were excluded. The patient population was divided to late stent removal group (LSR-POD 14) and early stent removal group (ESR-POD5). Our endpoints were total stent duration, 90-day readmission, 90-day total-UTI, 90-day urinary-readmissions, complications and Ureteroenteric Stricture (UES) rates. Statistical methods included t test, Chi-squared test and multivariate logistic regression. RESULTS One hundred and seventy-eight patients were included in the final analysis after inclusion/exclusion criteria were applied. The LSR (n = 74) and ESR (n = 104) groups were similar in preoperative characteristics except higher intracorporeal ileal conduit formation in ESR. The duration of stenting decreased significantly from approximately 15.5-5 days (P < 0.001). The LSR had higher 90-day overall readmission rates (OR = 2.57, 95% CI 1.19-5.53, P = 0.016) and total-UTIs (OR = 2.36, 95%CI 1.11-5.04, P = 0.026). With a median follow-up of 9.8 months, UES was similar between the two groups. CONCLUSION Shorter ureteral stent duration is a safe and non-inferior option following RCUD. It allows for stent removal prior to discharge and less outpatient visits. In addition, decreasing stent duration was linked decreased readmissions and total-UTIs without increased risk of UES. However, future studies are needed to establish causality and promote stent duration change.
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Affiliation(s)
- Hamza Beano
- Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA.
| | - Jiaxian He
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, USA
| | - Caitlin Hensel
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, USA
| | - William Worrilow
- Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA
| | - William Townsend
- Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA
| | - Kris Gaston
- Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA
| | - Peter E Clark
- Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA
| | - Stephen Riggs
- Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA
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Fedeli U, De Paoli A, Corti MC, Cacciamani GE, Gill IS, Zattoni F, Novara G, Porreca A, Artibani W. Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients. Urol Int 2020; 104:559-566. [PMID: 32272471 DOI: 10.1159/000506240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Population-based data on survival after radical cystectomy (RC) are lacking from Southern Europe. The aim of this study was to assess trends and determinants of perioperative mortality and long-term survival in the Veneto region (Northeastern Italy). METHODS All patients submitted to RC for bladder cancer from January 2004 to December 2016 were identified from the regional archive of hospital discharge records. Age at surgery, gender, comorbidities, hospital volume, calendar period of surgery, and type of urinary diversion were retrieved; vital status and cause of death were obtained by linkage with mortality records. Determinants of 90-day mortality were assessed by multilevel logistic regression; long-term survival was investigated by the Kaplan-Meier method and Cox regression. RESULTS Among 4,389 included patients, an increase in the share of patients aged ≥80 years (from 13% in 2004-2008 to 24% in 2013-2016, p < 0.001) and a decline in performing continent diversion (from 34.9 to 23.4%, p < 0.001) were observed across the study period. Ninety-day mortality did not change over time and was 4% for patients aged <70 years and 13.7% for those aged ≥80 years. Age- and comorbidities-adjusted mortality was significantly lower in hospitals performing >30 RCs/year (odds ratio 0.67, 95% confidence interval 0.48-0.93). At a median follow-up of 67 months, overall survival at 1 year and 5 years was 72 and 40%, respectively, with a higher rate among younger patients treated in high-volume hospitals. CONCLUSION The population of patients treated with RC is rapidly ageing, with a high risk of perioperative and long-term mortality; this changing epidemiological scenario and better outcomes observed in high-volume hospitals support regionalization of the procedure.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
| | | | | | - Giovanni Enrico Cacciamani
- Department of Urology, University of Verona, Verona, Italy.,USC Institute of Urology and the Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California, USA
| | - Inderbir S Gill
- USC Institute of Urology and the Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California, USA
| | - Filiberto Zattoni
- Urologic Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Giacomo Novara
- Urologic Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
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Voskamp MJH, Vermeer M, Molijn GJ, Cornel EB. The Usefulness of the Modified Frailty Index for Muscle-Invasive Bladder Cancer Patients Treated with Radical Cystectomy. Curr Urol 2020; 14:32-37. [PMID: 32398994 DOI: 10.1159/000499263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Radical cystectomy is still the gold standard for muscle-invasive bladder carcinoma (MIBC) treatment. In order to reduce postoperative complications, multimodality bladder-sparing therapies could be a good alternative. Studies in various malignancies have shown that the modified Frailty Index (mFI) may be more useful for identifying high-risk patients. Objectives We investigated the possible correlation between the mFI in cystectomy patients with MIBC and serious complications 30 and 90 days postoperatively. Methods Analysis of a prospective database of 109 consecutive MIBC patients who underwent a cystectomy between January 2012 and August 2017 was performed. The mFI was added retrospectively. Differences between groups were tested with independent t-tests, Mann-Whitney U tests, ANOVA, Kruskal-Wallis test, or Chi square tests as appropriate. Univariate and multivariate logistic regression analysis were performed to analyse the relation between the mFI and complications. Results Patients with Clavien-Dindo ≥ 3 at 30 and 90 days postoperatively had a significantly higher mFI compared to patients with Clavien-Dindo < 3: the odds ratio of the mFI for serious complications within 30 days was 1.5 (95% confidence interval 1.1-2.1, p = 0.010) and for 90 days was 1.5 (95% confidence interval 1.1-2.1, p = 0.008). Conclusions We found an association between a high mFI and postoperative complications and mortality. The mFI is therefore useful when discussing treatment options with MIBC patients.
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Affiliation(s)
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuis Groep Twente, Almelo, The Netherlands
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Liu Z, Meng Y, Li S, Yu W, Jin J. Perioperative recovery in different urinary reconstruction approaches of radical cystectomy: Are the advantages of laparoscopy consistent? J Minim Access Surg 2020; 16:390-398. [PMID: 31929226 PMCID: PMC7597872 DOI: 10.4103/jmas.jmas_227_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Radical cystectomy (RC) has complicated surgical procedures and various ways of urinary reconstruction. Aims: The aim of this study is to investigate whether the advantages of laparoscopy over open surgery were consistent in the perioperative recovery of different methods of urinary diversion after RC in the general and the elderly (>65 years) population. Settings and Design: A retrospective study reviewed 452 (elderly 261) patients who received RC from the year 2005–2012. Subjects and Methods: Of all, 88 patients underwent laparoscopic RC (LRC) and 364 patients underwent open RC (ORC). There were 325 patients received ileal conduit (IC), whereas 127 patients received cutaneous ureterostomy (CU). Statistical Analysis Used: We used different statistical methods (t-test, Chi-square, etc.) to compare variables outcomes. Results: For IC urinary diversion, the general patients undergoing LRC had less intra-operative blood loss (566.5 vs. 1320.3 ml, P < 0.001), lower blood transfusion rate (11.4 vs. 34.1%, P < 0.001), shorter gastrointestinal recovery time (5.7 vs. 6.7 days, P = 0.002) and shorter length of hospital stay (LOS) (21.7 vs. 26.0 days, P = 0.003) than patients receiving ORC. Similar trends were observed in older patients. For CU urinary diversion, the general and the elderly patients receiving LRC had a shorter mean time to gastrointestinal recovery (P = 0.017, P < 0.001, respectively) than patients receiving ORC. No differences were found between LRC and ORC in intra-operative blood loss, allogeneic blood transfusion rate and LOS. Conclusions: In the general and the elderly population, laparoscopic approach could result in more rapid rehabilitation for RC patients, especially in the IC patients.
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Affiliation(s)
- Zhenhua Liu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
| | - Yisen Meng
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
| | - Shaobo Li
- Department of Pathology, School of Basic Medicine, Fudan University, Shanghai, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
| | - Jie Jin
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing, China
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Kikuchi E, Hayakawa N, Fukumoto K, Shigeta K, Matsumoto K. Bacillus Calmette–Guérin‐unresponsive non‐muscle‐invasive bladder cancer: Its definition and future therapeutic strategies. Int J Urol 2019; 27:108-116. [DOI: 10.1111/iju.14153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/22/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Eiji Kikuchi
- Department of Urology St. Marianna University School of Medicine Kanagawa Japan
| | - Nozomi Hayakawa
- Department of Urology Keio University School of Medicine Tokyo Japan
| | - Keishiro Fukumoto
- Department of Urology Keio University School of Medicine Tokyo Japan
| | - Keisuke Shigeta
- Department of Urology Keio University School of Medicine Tokyo Japan
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Prediction of early (30-day) and late (30–90-day) mortality after radical cystectomy in a comprehensive cancer centre over two decades. World J Urol 2019; 38:2197-2205. [DOI: 10.1007/s00345-019-03011-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022] Open
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38
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Moschini M, Shariat SF, Black P, Kamat AM, Stabile A, Cathelineau X, Kassouf W, Bochner BH, Xylinas E, Roupret M, Boorjian SA, Catto JW, Sanchez-Salas R. Do Not Learn a Technique, Learn the Biology Underlying the Disease: Techniques Evolve, Biology Prevails. Eur Urol 2019; 77:1-2. [PMID: 31506227 DOI: 10.1016/j.eururo.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022]
Abstract
The evidence available suggests that open and robot-assisted radical cystectomy lead to similar outcomes in bladder cancer. True advances will come from a better understanding of the biology of the disease, and a comprehensive, multimodal approach that aims to improve patient survival and quality of life is more critical than the surgical technique.
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Affiliation(s)
- Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology, Institut Mutualiste Montsouris, Paris, France; Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Black
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Bernard H Bochner
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Morgan Roupret
- Urology Department, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - James W Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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39
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Waingankar N, Mallin K, Egleston BL, Winchester DP, Uzzo R, Kutikov A, Smaldone M. Trends in Regionalization of Care and Mortality For Patients Treated With Radical Cystectomy. Med Care 2019; 57:728-733. [PMID: 31313685 PMCID: PMC7537145 DOI: 10.1097/mlr.0000000000001143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Regionalization to higher volume centers has been proposed as a mechanism to improve short-term outcomes following complex surgery. OBJECTIVE The objective of this study was to assess trends in regionalization and mortality for patients undergoing radical cystectomy (RC). RESEARCH DESIGN An observational study of patients receiving RC in the United States from 2004 to 2013. SUBJECTS Data for patients receiving RC were extracted from the National Cancer Database. MEASURES The primary exposure was hospital volume; low-volume hospitals (LVH) included those with <5 RC/year and high-volume hospitals (HVH) were those with ≥30 RC/year. Trends in the volume were assessed, as were 30- and 90-day mortality. Cochrane-Armitage tests were performed for volume, and propensity score-weighted proportional hazard regression was used to assess mortality. RESULTS A total of 47,028 RC were performed in 1162 hospitals from 2004 to 2013. The proportion of RC at LVH declined from 29% to 17% (P<0.01), whereas that of HVH increased from 16% to 33% (P<0.01). Unadjusted 30- (P=0.02) and 90-day (P<0.001) mortality decreased, and the absolute decrease was greatest at LVH (4.8% vs. 2.6%, P=0.03), whereas rates for HVH remained stable (1.9% vs. 1.4%, P=0.34). Following risk-adjustment, relative to treatment at HVH, treatment at LVH was associated with increased 30-day (hazard ratio: 1.66, 95% CI: 1.53-1.80) and 90-day mortality (hazard ratio: 1.37, 95% confidence interval: 1.30-1.44). CONCLUSIONS Regionalization of RC to HVH was observed from 2004 to 2013. Treatment at LVH was associated with 66% and 33% relative increases in hazard of death at 30 and 90 days, respectively. These findings support the selective referral of complex cases to higher volume centers.
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Affiliation(s)
| | - Katherine Mallin
- American College of Surgeons, National Cancer Database, Chicago, IL
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40
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Regmi SK, Konety BR. Studying the impact of comorbidity on post radical cystectomy survival: have we come a full circle? Transl Androl Urol 2019; 8:S314-S317. [PMID: 31392156 DOI: 10.21037/tau.2019.06.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Subodh K Regmi
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
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Liaw CW, Winoker JS, Wiklund P, Sfakianos J, Galsky MD, Mehrazin R. The clinical and economic burden of perioperative complications of radical cystectomy. Transl Androl Urol 2019; 8:S277-S279. [PMID: 31392144 DOI: 10.21037/tau.2019.03.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Christine W Liaw
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jared S Winoker
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Sfakianos
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D Galsky
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Balakrishnan AS, Washington SL, Meng MV, Porten SP. Determinants of Guideline-Based Treatment in Patients With cT1 Bladder Cancer. Clin Genitourin Cancer 2019; 17:e461-e471. [DOI: 10.1016/j.clgc.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 11/25/2022]
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Coughlin GD, Youl PH, Philpot S, Wright MJ, Honore M, Theile DE. Outcomes following radical cystectomy: a population-based study from Queensland, Australia. ANZ J Surg 2019; 89:752-757. [PMID: 31087817 DOI: 10.1111/ans.15259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radical cystectomy (RC) is a complex uro-oncology surgical procedure with high surgical morbidity. We report on outcomes following RC for bladder cancer using a population-based cohort of patients. METHODS Patients receiving an RC from 2002 to 2016 were included and linked to their cancer-related surgical procedures. Hospitals were categorized as high (>7 RCs/year) and low (≤7 RCs/year). Outcomes included 30- and 90-day mortalities and 2-year overall survival (OS). Multivariable logistic regression models were used to examine factors associated with the outcomes of interest. OS was estimated using the Kaplan-Meier survival function. RESULTS During the 15-year study period, 1230 patients underwent an RC for invasive bladder cancer. In-hospital mortality was 1.1%, and 30- and 90-day mortality was 1.4% and 2.9%, respectively. Both 30- and 90-day mortalities were significantly higher for older versus younger patients (P = 0.01 and P < 0.001, respectively), and lymph node involvement was significantly associated with 90-day mortality (P = 0.002). Patients treated more recently were about 80% less likely to die within 90 days. The 2-year OS was 71.5%, with significant improvements observed over time (P < 0.001). While we found no evidence of a hospital-volume relationship for post-operative mortality or survival, patients treated in low-volume compared to high-volume hospitals were more likely to have surgical margin involvement (10.9% versus 7.1%, respectively, P = 0.03). CONCLUSION We observed low post-operative mortality rates overall, with rates decreasing significantly over time. Some subgroups of patients experience poorer post-operative outcomes. Reporting on post-operative outcomes, and survival over time helps monitor clinical progress and identify areas for improvement.
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Affiliation(s)
- Geoffrey D Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Shoni Philpot
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Matthew J Wright
- Department of Surgery, University of Florida, Gainsville, Florida, USA
| | - Matthew Honore
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David E Theile
- Cancer Alliance Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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Liedberg F, Hagberg O, Aljabery F, Gårdmark T, Hosseini A, Jahnson S, Jancke G, Jerlström T, Malmström PU, Sherif A, Ströck V, Häggström C, Holmberg L. Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study. BJU Int 2019; 124:449-456. [DOI: 10.1111/bju.14767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Fredrik Liedberg
- Department of Urology; Skåne University Hospital; Malmö Sweden
- Institution of Translational Medicine; Lund University; Malmö Sweden
| | | | - Firas Aljabery
- Division of Urology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences; Karolinska Institute; Danderyd Hospital; Stockholm Sweden
| | - Abolfazl Hosseini
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Staffan Jahnson
- Division of Urology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Georg Jancke
- Department of Urology; Skåne University Hospital; Malmö Sweden
- Institution of Translational Medicine; Lund University; Malmö Sweden
| | - Tomas Jerlström
- Department of Urology; School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | | | - Amir Sherif
- Department of Surgical and Perioperative Sciences; Urology and Andrology; Umeå University; Umeå Sweden
| | - Viveka Ströck
- Department of Urology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Christel Häggström
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
- Department of Biobank Research; Umeå University; Umeå Sweden
| | - Lars Holmberg
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
- School of Medicine; King's College London; London UK
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45
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Leow JJ, Bedke J, Chamie K, Collins JW, Daneshmand S, Grivas P, Heidenreich A, Messing EM, Royce TJ, Sankin AI, Schoenberg MP, Shipley WU, Villers A, Efstathiou JA, Bellmunt J, Stenzl A. SIU–ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer. World J Urol 2019; 37:61-83. [DOI: 10.1007/s00345-018-2606-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
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Elmussareh M, Simonsen PC, Young M, Kingo PS, Jakobsen JK, Jensen JB. Correlation between organ-specific co-morbidities and complications in bladder cancer patients undergoing radical cystectomy. Scand J Urol 2019; 52:395-400. [PMID: 30624138 DOI: 10.1080/21681805.2018.1531921] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the association between patients' organ-specific co-morbidities and post-operative complications following radical cystectomy for bladder cancer. PATIENTS AND METHODS All patients who underwent radical cystectomy at Aarhus University Hospital during the period from January 2006 to February 2014 were included retrospectively. A total of 40 comorbidities and 59 complications were registered meticulously. Univariate and multivariate analyses were used to detect associations between the individual comorbidities and specific post-operative complications. RESULTS Ninety-two per cent (575/625) of patients experienced one or more complications following radical cystectomy. Clavien-Dindo grade 3-5 complications were observed in 40.8% of patients, and 6.2% had severe complications (Clavien-Dindo grade 4-5). The mortality rate was 2.2%. High BM, previous myocardial infarction and chronic obstructive pulmonary disease were noted to be associated with moderate-to-severe post-operative complications (Clavien-Dindo grade 3-5), while diabetes and lymphoproliferative disorders were significantly associated with severe complications (Clavien-Dindo grade 4-5). CONCLUSION This study demonstrates that overall complications to radical cystectomy are high (92%). The associations between specific comorbidities and complications need to be further investigated in order to evaluate whether pre-operative assessment can be more optimally used in a prevention strategy tailored to the individual patient.
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Affiliation(s)
- Muhammad Elmussareh
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,b Department of Urology , Mid Yorkshire Hospitals NHS Trust , Wakefield , UK
| | | | - Matthew Young
- b Department of Urology , Mid Yorkshire Hospitals NHS Trust , Wakefield , UK
| | | | | | - Jørgen Bjerggaard Jensen
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,c Department of Clinical Medicine , Health, Aarhus University , Aarhus , Denmark
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47
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Haque W, Butler EB, Teh BS. Clinical benefit to regionalization of care for muscle invasive bladder cancer. Transl Androl Urol 2018; 7:S98-S100. [PMID: 29645016 PMCID: PMC5881207 DOI: 10.21037/tau.2018.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
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48
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Xia L, Strother MC, Taylor BL, Chelluri RR, Pulido JE, Guzzo TJ. Hospital volume and short-term outcomes after cytoreductive nephrectomy. J Surg Oncol 2018; 117:1589-1596. [PMID: 29575038 DOI: 10.1002/jso.25047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the impact of hospital volume on short-term outcomes after cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). METHODS We identified mRCC patients who underwent CN from 2006 to 2013 in the National Cancer Database. Annual hospital CN volume was categorized as high (top 20th percentile) and low. Multivariable logistic regressions were used to compare 30-day mortality, 90-day mortality, prolonged length of stay (PLOS, ≥7 days), and 30-day readmission rates. Sensitivity analyses were performed with hospital volume considered as a continuous variable. RESULTS A total of 9789 patients were included with high-volume (n = 1916) defined as ≥8 cases and low-volume (n = 7873) as 1-7 cases annually. Multivariable logistic regression showed that high-volume was associated with lower odds of 30-day mortality (OR = 0.69, P = 0.013), 90-day mortality (OR = 0.65, P < 0.001), PLOS (OR = 0.82, P = 0.002), and 30-day readmission (OR = 0.78, P = 0.028). Sensitivity analyses showed that increasing hospital volume (per case) was associated with lower odds of 30-day mortality (OR = 0.965, P = 0.008), 90-day mortality (OR = 0.966, P < 0.001), PLOS (OR = 0.982, P = 0.001), and 30-day readmission (OR = 0.975, P = 0.012). CONCLUSION Higher hospital volume was associated with better short-term outcomes after CN. Future studies are needed to validate our findings and explore the potential components leading to better outcomes in the higher volume hospitals.
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Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marshall C Strother
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Raju R Chelluri
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jose E Pulido
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Vallejo-Torres L, Melnychuk M, Vindrola-Padros C, Aitchison M, Clarke CS, Fulop NJ, Hines J, Levermore C, Maddineni SB, Perry C, Pritchard-Jones K, Ramsay AIG, Shackley DC, Morris S. Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services. Br J Surg 2018; 105:587-596. [PMID: 29512137 PMCID: PMC5900867 DOI: 10.1002/bjs.10761] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
Abstract
Background Centralizing specialist cancer surgery services aims to reduce variations in quality of care and improve patient outcomes, but increases travel demands on patients and families. This study aimed to evaluate preferences of patients, health professionals and members of the public for the characteristics associated with centralization. Methods A discrete‐choice experiment was conducted, using paper and electronic surveys. Participants comprised: former and current patients (at any stage of treatment) with prostate, bladder, kidney or oesophagogastric cancer who previously participated in the National Cancer Patient Experience Survey; health professionals with experience of cancer care (11 types including surgeons, nurses and oncologists); and members of the public. Choice scenarios were based on the following attributes: travel time to hospital, risk of serious complications, risk of death, annual number of operations at the centre, access to a specialist multidisciplinary team (MDT) and specialist surgeon cover after surgery. Results Responses were obtained from 444 individuals (206 patients, 111 health professionals and 127 members of the public). The response rate was 52·8 per cent for the patient sample; it was unknown for the other groups as the survey was distributed via multiple overlapping methods. Preferences were particularly influenced by risk of complications, risk of death and access to a specialist MDT. Participants were willing to travel, on average, 75 min longer in order to reduce their risk of complications by 1 per cent, and over 5 h longer to reduce risk of death by 1 per cent. Findings were similar across groups. Conclusion Respondents' preferences in this selected sample were consistent with centralization. Most favour it
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Affiliation(s)
- L Vallejo-Torres
- Department of Applied Health Research, University College London, London, UK.,Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - M Melnychuk
- Department of Applied Health Research, University College London, London, UK
| | - C Vindrola-Padros
- Department of Applied Health Research, University College London, London, UK
| | - M Aitchison
- Department of Renal and Nephrology Services, Royal Free London NHS Foundation Trust, London, UK
| | - C S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - N J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - J Hines
- Urology Department, University College London Hospital, London, UK
| | - C Levermore
- University College London Hospitals Cancer Collaborative, University College London Hospitals NHS Foundation Trust, London, UK
| | - S B Maddineni
- Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
| | - C Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - K Pritchard-Jones
- University College London Hospitals Cancer Collaborative, University College London Hospitals NHS Foundation Trust, London, UK.,Academic Health Science Network Cancer Programme, University College London Partners, London, UK
| | - A I G Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - D C Shackley
- Greater Manchester Cancer, hosted by Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
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50
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Groeben C, Koch R, Baunacke M, Schmid M, Borkowetz A, Wirth MP, Huber J. Urinary Diversion After Radical Cystectomy for Bladder Cancer: Comparing Trends in the US and Germany from 2006 to 2014. Ann Surg Oncol 2018; 25:3502-3509. [DOI: 10.1245/s10434-018-6381-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Indexed: 11/18/2022]
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