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Does minimally invasive surgery for bladder cancer result in unusual sites of metastasis? Actas Urol Esp 2021; 45:512-519. [PMID: 34330694 DOI: 10.1016/j.acuroe.2021.06.002] [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: 03/10/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To compare sites of metastasis for the laparoscopic (LRC) and open (ORC) approaches in a cohort of patients at a district general hospital. Morbidity and mortality for the two approaches are assessed using secondary outcomes of length of stay and complication rate. Metastasis rate and site are compared. METHODS A retrospective case note review was carried out for all patients who underwent cystectomy for bladder malignancy at Pinderfields General Hospital, Wakefield between 2010 and 2016 (n = 219). There were 150 males and 69 females in 107 minimally invasive cases and 87 open (missing data on 25 cases). Data were analysed using Microsoft Excel XLSTAT. RESULTS Recurrence rate was 25.1% and did not differ significantly with approach (p = 0.89). Sites of recurrence did not differ with operative approach, the most frequent being pelvis, chest and bone. Unusual sites of recurrence included abdominal wall and sigmoid colon which both occurred in LRC. Length of stay was greater for the open approach (median LRC = 10, ORC = 13, p < 0.01). Five-year survival was 74.9%. Survival distribution did not significantly differ with operative approach (p = 0.43), and there was no significant association between operative approach and patient death within the follow-up period (p = 0.09). Stricture rate was 4.1% and was not significantly different between the 2 groups (p = 0.29). Median time to stricture was 130 days. Clavien-Dindo scores for complications did not differ with approach (p = 0.93), and there was no significant association between operative approach and whether complications developed (p = 0.19). CONCLUSIONS The adverse oncological outcomes in minimally invasive approaches suggested by some studies are not confirmed here. Those in the LRC group were discharged sooner, though this did not translate into differences in morbidity or survival. Analysis of the association between individual complications and length of stay may clarify this further. Shorter hospital stay is also likely to have significant financial implications. Despite no significant difference in outcomes, the findings demonstrate potential benefits of LRC. Extensions of this study could include: cost-benefit analysis, examination of individual complications' effect on length of stay; and analysis of approach-specific factors contributing to perioperative deaths.
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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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Does minimally invasive surgery for bladder cancer result in unusual sites of metastasis? Actas Urol Esp 2021. [PMID: 33744023 DOI: 10.1016/j.acuro.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare sites of metastasis for the laparoscopic (LRC) and open (ORC) approaches in a cohort of patients at a district general hospital. Morbidity and mortality for the two approaches are assessed using secondary outcomes of length of stay and complication rate. Metastasis rate and site are compared. METHODS A retrospective case note review was carried out for all patients who underwent cystectomy for bladder malignancy at Pinderfields General Hospital, Wakefield between 2010 and 2016 (n=219). There were 150 males and 69 females in 107 minimally invasive cases and 87 open (missing data on 25 cases). Data were analysed using Microsoft Excel XLSTAT. RESULTS Recurrence rate was 25.1% and did not differ significantly with approach (p=0.89). Sites of recurrence did not differ with operative approach, the most frequent being pelvis, chest and bone. Unusual sites of recurrence included abdominal wall and sigmoid colon which both occurred in LRC. Length of stay was greater for the open approach (median LRC=10, ORC=13, p<0.01). Five-year survival was 74.9%. Survival distribution did not significantly differ with operative approach (p=0.43), and there was no significant association between operative approach and patient death within the follow-up period (p=0.09). Stricture rate was 4.1% and was not significantly different between the two groups (p=0.29). Median time to stricture was 130 days. Clavien-Dindo scores for complications did not differ with approach (p=0.93), and there was no significant association between operative approach and whether complications developed (p=0.19). CONCLUSIONS The adverse oncological outcomes in minimally invasive approaches suggested by some studies are not confirmed here. Those in the LRC group were discharged sooner, though this did not translate into differences in morbidity or survival. Analysis of the association between individual complications and length of stay may clarify this further. Shorter hospital stay is also likely to have significant financial implications. Despite no significant difference in outcomes, the findings demonstrate potential benefits of LRC. Extensions of this study could include: cost-benefit analysis, examination of individual complications' effect on length of stay; and analysis of approach-specific factors contributing to perioperative deaths.
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Uemura T, Ishibashi T, Pae S, Shirakawa N, Somoto T, Shinohara M, Kobayashi M, Komaru A, Fukasawa S. [CLINICAL STUDY OF OPEN RADICAL CYSTECTOMY AND ILEAL CONDUIT CONSTRUCTION FOR BLADDER CANCER: RESULTS OF 15-YEAR SINGLE CENTER EXPERIENCE]. Nihon Hinyokika Gakkai Zasshi 2021; 112:89-95. [PMID: 35444087 DOI: 10.5980/jpnjurol.112.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
(Objective) We retrospectively analyzed clinical outcome, prognostic factors and adjuvant chemotherapy for bladder cancer patients with open radical cystectomy (ORC) combined with ileal conduit construction (ICC). (Patients and methods) From February 2005 to February 2019, 179 patients underwent ORC and ICC for invasive bladder cancer or BCG unresponsive non-muscle invasive bladder cancer. We investigated intraoperative and early postoperative complications, overall survival (OS), cancer-specific survival (CSS), and poor prognostic factors affecting OS. Furthermore, we evaluated the prognosis of patients with pT3,4 or pN1-3 depending on adjuvant chemotherapy. (Results) Clavien-Dindo Grade 4 or 5 complications were not occurred. The 5-year and 10-year OS probability were 71.1% and 57.4%, respectively, while the 5-year and 10-year CSS probability were 76.5% and 71.5%, respectively. Multivariate analysis revealed that male (HR = 2.70, 95%CI [0.97-7.51]), pT3,4 (HR = 1.83, 95%CI [1.05-3.21]), and pN1-3 (HR = 2.85, 95%CI [1.62-5.03]) were independent poor prognostic factors. Adjuvant chemotherapy significantly improved OS (p = 0.03) and CSS (p = 0.017) in pN1-3 patients. (Conclusion) ORC combined with ICC was an effective operative method, and good results were obtained. Adjuvant chemotherapy may be effective for patients with positive regional lymph nodes.
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Affiliation(s)
| | | | - Sangjon Pae
- Prostate Center and Division of Urology, Chiba Cancer
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Kobayashi K, Goel A, Coelho MP, Medina Perez M, Klumpp M, Tewari SO, Appleton-Figueira T, Pinter DJ, Shapiro O, Jawed M. Complications of Ileal Conduits after Radical Cystectomy: Interventional Radiologic Management. Radiographics 2020; 41:249-267. [PMID: 33306453 DOI: 10.1148/rg.2021200067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since their introduction into clinical practice in the 1950s, ileal conduits have been the most common type of urinary diversion used after radical cystectomy worldwide. Although ileal conduits are technically simpler to construct than other forms of urinary diversion, a variety of complications can occur in the early and late postoperative periods. Early complications include urine leakage, urinary obstruction, postoperative fluid collection (eg, urinoma, hematoma, lymphocele, or abscess), and fistula formation. Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit. Interventional radiologists can play a pivotal role in diagnosis and management of these complications by performing image-guided minimally invasive procedures. In this article, the authors review the surgical anatomy of an ileal conduit and the underlying pathophysiology of and diagnostic workup for complications related to ileal conduits. The authors also discuss and illustrate current approaches to interventional radiologic management of these complications, with emphasis on a collaborative approach with urologists or endourologists to best preserve patients' renal function and maintain their quality of life. ©RSNA, 2020.
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Affiliation(s)
- Katsuhiro Kobayashi
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Atin Goel
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Marlon P Coelho
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Mariangeles Medina Perez
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Matthew Klumpp
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Sanjit O Tewari
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Tomas Appleton-Figueira
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - David J Pinter
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Oleg Shapiro
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Mohammed Jawed
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
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Zaghloul MS, Zaghloul TM, Bishr MK, Baumann BC. Urinary schistosomiasis and the associated bladder cancer: update. J Egypt Natl Canc Inst 2020; 32:44. [DOI: 10.1186/s43046-020-00055-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Urinary schistosomiasis and its severe complications, mainly bladder cancer, are scarce in non-endemic areas. The deficiency in knowledge and clinical experience of schistosomiasis may lead to inadequate management. Highlighting these topics may be of value, especially with the increased immigration from endemic low-/middle-income countries (LMIC) to non-endemic high-income countries (HIC). Schistosomiasis is a parasitic infection endemic in many low- and middle-income countries. It can affect various systems but is best known for its effect on the urinary system.
Main Body
PubMed, Scopus, Google Scholar, and the Cochrane Library databases were searched for urinary schistosomiasis and its related bladder cancer published from 1980 till 2020.
Schistosoma haematobium (SH) infecting the urinary bladder was considered by the IARC as group 1 definitive biological carcinogenic agent. Several carcinogenic pathways have been postulated but the exact mechanism(s) are not defined yet. A more thorough understanding of the parasite life cycle was explored to help eradicate the infection especially for the immigrants from endemic areas. This may prevent or slow down the process of carcinogenesis that leads to Schistosoma-associated bladder cancer (SA-BC), which is usually, but not conclusively, squamous cell carcinoma. Treatment of SA-BC generally follows the same guidelines as urothelial Schistosoma-non-associated bladder cancer (SNA-BC) management; however, prospective trials to confirm and refine the treatment approach for SA-BC have been relatively limited.
Conclusion
The available data showed that despite some etiologic and carcinogenic differences, the oncologic outcomes are generally comparable for SA-BC and NSA-BC when adjusting for stage, risk status, and comorbidities.
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Guo L, Zhang L, Wang J, Zhang X, Zhu Z. Pelvic Lymph Node Dissection During Cystectomy for Patients With Bladder Carcinoma With Variant Histology: Does Histologic Type Matter? Front Oncol 2020; 10:545921. [PMID: 33194603 PMCID: PMC7604421 DOI: 10.3389/fonc.2020.545921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Adding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants. Methods Within the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type. Results Histologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557-0.634 [P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494-0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107-0.504 [P < 0.001]), whereas no significant differences in OS were observed in other histological subsets. Discussion Our analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated.
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Affiliation(s)
- Lijuan Guo
- Department of Disease Prevention and Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lianghao Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiange Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaowei Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ogawa K, Shimizu Y, Uketa S, Utsunomiya N, Kanamaru S. Prognosis of patients with muscle invasive bladder cancer who are intolerable to receive any anti-cancer treatment. Cancer Treat Res Commun 2020; 24:100195. [PMID: 32688293 DOI: 10.1016/j.ctarc.2020.100195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/16/2020] [Accepted: 07/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the prognosis of patients who had been diagnosed with muscle invasive bladder cancer (MIBC) and did not receive anti-cancer treatment because of their physical characteristics. METHODS Between January 2012 and October 2019, 96 patients were diagnosed with MIBC (cT2-4N0M0) in our institution. Of those, 64 patients had undergone radical cystectomy (RC), 6 had received palliative radiation therapy, and 26 had not received any anti-cancer treatment. We further evaluated the 26 patients who had received no anti-cancer treatment. RESULTS The no anti-cancer treatment group were significantly older (91 vs. 75 years, p<0.001), comprised fewer men (42% vs. 72%, p=0.015), and had poorer performance status (PS) (mean 2.69 vs. 0.32, p<0.001) than the RC group. The follow periods were 9.5 months and 28.5 months, respectively. Median overall survival (OS) was 12 months in the no anti-cancer treatment group, whereas the median OS was not reached during the study period in the RC group. In univariate analysis, OS was significantly associated with estimated GFR (eGFR) less than 30 mL/min/1.73m2 (median OS, 10 vs 16 months, p = 0.044). Multivariate analysis demonstrated that eGFR was significantly associated with OS (hazards ratio 0.267 [95% CI 0.0858-0.8357]; p = 0.0023). CONCLUSIONS We evaluated the prognosis of patients with untreated MIBC. Their median OS was 12 months and eGFR was a significant prognostic factor. These findings may help in counseling patients about prognosis if no anti-cancer treatment is given.
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Affiliation(s)
- Kosuke Ogawa
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-chome Nishiku, Kobe 651-2273, Hyogo, Japan.
| | - Yousuke Shimizu
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-chome Nishiku, Kobe 651-2273, Hyogo, Japan
| | - Shoko Uketa
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-chome Nishiku, Kobe 651-2273, Hyogo, Japan
| | - Noriaki Utsunomiya
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-chome Nishiku, Kobe 651-2273, Hyogo, Japan
| | - Sojun Kanamaru
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-chome Nishiku, Kobe 651-2273, Hyogo, Japan
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Hayashi Y, Fujita K. A new era in the detection of urothelial carcinoma by sequencing cell-free DNA. Transl Androl Urol 2019; 8:S497-S501. [PMID: 32042630 PMCID: PMC6989842 DOI: 10.21037/tau.2019.08.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- Yujiro Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Moschini M, Soria F, Mathieu R, Xylinas E, D'Andrea D, Tan WS, Kelly JD, Simone G, Tuderti G, Meraney A, Krishna S, Konety B, Zamboni S, Baumeister P, Mattei A, Briganti A, Montorsi F, Galucci M, Rink M, Karakiewicz PI, Rouprêt M, Aziz A, Perry M, Rowe E, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Sooriakumaran P, Shariat SF. Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy. Urol Oncol 2019; 37:179.e1-179.e7. [DOI: 10.1016/j.urolonc.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/27/2022]
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Jønck S, Helgstrand JT, Røder MA, Klemann N, Grønkaer Toft B, Brasso K. The prognostic impact of incidental prostate cancer following radical cystoprostatectomy: a nationwide analysis. Scand J Urol 2019; 52:358-363. [PMID: 30624125 DOI: 10.1080/21681805.2018.1534885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To determine the prevalence and prognostic impact of incidental prostate cancer in patients undergoing radical cystoprostatectomy. METHODS A nationwide population-based study of incidental prostate cancer diagnosed following radical cystoprostatectomy. Information on vital status, Gleason score, positive and negative tumor margins, pT-category and subsequent prostate cancer therapies were obtained from the Danish Prostate Cancer Registry and by manual chart review. RESULTS A total of 1,450 men who underwent radical cystoprostatectomy in Denmark from 1995-2011 were identified. Forty-six men were excluded from analysis, thus 1,404 patients were eligible. The median follow-up was 7.8 years. A total of 466 (33.2%) had incidental prostate cancer diagnosed. No statistical differences in 10- and 15-year cumulative overall mortality were observed when comparing men with, or without, incidental prostate cancer. In men diagnosed with incidental prostate cancer, neither Gleason score, positive surgical margins or locally advanced prostate cancer (pT3-4) was associated with mortality. Only 0.9% received post-operative prostate cancer-related treatment. CONCLUSION In this population-based cohort of patients with incidental prostate cancer diagnosed at radical cystoprostatectomy, we found no impact of incidental prostate cancer on overall mortality, regardless of Gleason score, surgical margin status and pathological T-category. Patients diagnosed with incidental prostate cancer following radical cystoprostatectomy are unlikely to benefit from additional follow-up.
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Affiliation(s)
- Simon Jønck
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - John Thomas Helgstrand
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Martin Andreas Røder
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Nina Klemann
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Birgitte Grønkaer Toft
- b Department of Pathology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Klaus Brasso
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
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Avulova S, Chang SS. Role and Indications of Organ-Sparing "Radical" Cystectomy: The Importance of Careful Patient Selection and Counseling. Urol Clin North Am 2018; 45:199-214. [PMID: 29650136 DOI: 10.1016/j.ucl.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Organ-sparing cystectomy remains an operation for a highly selected patient population that can offer similar oncologic outcomes but improved sexual function in men and women. Occult prostate cancer in men may occur even with screening but the majority is of clinical insignificance. Paramount to patient selection are oncologic concerns, but preoperative sexual function, age, performance status, and postoperative expectations must also be evaluated during patient selection. Improved diagnostic and surveillance tools may facilitate and improve patient selection in the future.
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Affiliation(s)
- Svetlana Avulova
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA.
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA
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Prack Mc Cormick B, Langle Y, Belgorosky D, Vanzulli S, Balarino N, Sandes E, Eiján AM. Flavonoid silybin improves the response to radiotherapy in invasive bladder cancer. J Cell Biochem 2018; 119:5402-5412. [PMID: 29363820 DOI: 10.1002/jcb.26693] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/22/2018] [Indexed: 11/11/2022]
Abstract
Conservative treatment for invasive bladder cancer (BC) involves a complete transurethral tumor resection combined with chemotherapy (CT) and radiotherapy (RT). The major obstacles of chemo-radiotherapy are the addition of the toxicities of RT and CT, and the recurrence due to RT and CT resistances. The flavonoid Silybin (Sb) inhibits pathways involved in cell survival and resistance mechanisms, therefore the purpose of this paper was to study in vitro and in vivo, the ability of Sb to improve the response to RT, in two murine BC cell lines, with different levels of invasiveness, placing emphasis on radio-sensitivity, and pathways involved in radio-resistance and survival. In vitro, Sb radio-sensitized murine invasive cells through the inhibition of RT-induced NF-κB and PI3K pathways, and the increase of oxidative stress, while non-invasive cells did not show to be sensitized. In vivo, Sb improved RT-response and overall survival in invasive murine tumors. As Sb is already being tested in clinical trials for other urological cancers and it improves RT-response in invasive BC, these results could have translational relevance, supporting further research.
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Affiliation(s)
- Barbara Prack Mc Cormick
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina.,Universidad Nacional de Lomas de Zamora, Facultad de Ciencias Agrarias, Laboratorio de Suelos, Buenos Aires, Argentina
| | - Yanina Langle
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina
| | - Denise Belgorosky
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
| | - Silvia Vanzulli
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina.,Academia Nacional de Medicina, Ciudad de Buenos Aires, Argentina
| | - Natalia Balarino
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
| | - Eduardo Sandes
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina
| | - Ana M Eiján
- Universidad de Buenos Aires, Instituto de Oncología "Ángel H. Roffo", Área de Investigaciones, Ciudad de Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
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Park J, Jeong H. Morbidity, Mortality, and Survival for Radical Cystectomy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Manig L, Janssen S, Schild SE, Rades D. A New Prognostic Tool for Patients Undergoing Radiotherapy plus Upfront Transurethral Resection for Bladder Cancer. ACTA ACUST UNITED AC 2017; 31:745-748. [PMID: 28652451 DOI: 10.21873/invivo.11125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023]
Abstract
AIM To create a tool to estimate overall survival (OS) of patients with non-metastatic bladder cancer. PATIENTS AND METHODS Eight parameters were retrospectively evaluated for OS in 42 patients undergoing radiotherapy and upfront transurethral resection for bladder cancer. The prognostic tool included those parameters that were significant on both univariate and multivariate analyses. The tool was based on the 3-year OS rate divided by 10. Patient scores were calculated by adding the points for each significant parameter. RESULTS On univariate analysis, 3-year OS was associated with gender (p=0.017), pack years (p=0.009) and Karnofsky performance score (KPS) (p<0.001). On Cox regression, pack years (p=0.007) and KPS (p<0.001) remained significant and were incorporated into the tool. Three prognostic groups were designated with 6, 10-11 and 15 points with 3-year OS-rates of 0%, 34% and 83%, respectively (p<0.001). CONCLUSION A tool was developed to estimate the OS of patients with bladder cancer to improve individualization of treatment.
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Affiliation(s)
- Lisa Manig
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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16
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Käsmann L, Manig L, Janssen S, Rades D. Chemoradiation Including Paclitaxel for Locally Recurrent Muscle-invasive Bladder Cancer in Elderly Patients. ACTA ACUST UNITED AC 2017; 31:239-241. [PMID: 28358706 DOI: 10.21873/invivo.11051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM To evaluate outcomes and toxicities of chemoradiation with a less intensive paclitaxel regimen for locally recurrent bladder cancer. PATIENTS AND METHODS Three elderly patients received simultaneous chemoradiation for recurrent muscle-invasive bladder cancer. Chemotherapy included two courses (three times 25 mg/m2 over 1.5 weeks) of paclitaxel. Radiotherapy doses were 59.4 Gy to the bladder and 50.4 Gy to regional lymph nodes. Survival, local control and toxicities were retrospectively evaluated. RESULTS One patient died after 71 months, two were alive after 69 and 98 months, respectively. No local recurrence was not observed. Five-year survival and local control rates were 100%. Two patients experienced grade 1 acute dysuria, one patient grade 1 diarrhea. Late toxicities were also mild; two patients had grade 1 dysuria. CONCLUSION Chemoradiation with a less intensive paclitaxel regimen resulted in excellent 5-year results and was very well tolerated. It may be a reasonable option for elderly patients who cannot tolerate more intensive approaches.
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Affiliation(s)
- Lukas Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Lisa Manig
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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17
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Sargos P, Larré S, Chapet O, Latorzeff I, Fléchon A, Roubaud G, Orré M, Belhomme S, Richaud P. [Adjuvant radiotherapy for bladder cancer in patients with risk of locoregional recurrence: Who, what and how?]. Cancer Radiother 2017; 21:67-72. [PMID: 28187997 DOI: 10.1016/j.canrad.2016.08.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/26/2016] [Accepted: 08/03/2016] [Indexed: 01/22/2023]
Abstract
Radical cystectomy with extended pelvic lymph node dissection remains the standard of care for non-metastatic muscle-invasive bladder cancer. Locoregional control is a key factor in the outcome of patients since it is related to overall survival, metastasis-free survival and specific survival. Locoregional recurrence rate is directly correlated to pathological results and the quality of lymphadenectomy. In addition, while pre- or postoperative chemotherapy improved overall survival, it showed no impact on locoregional recurrence-free survival. Several recent publications have led to the development of a nomogram that predicts the risk of locoregional recurrence, in order to identify patients for which adjuvant radiotherapy could be beneficial. International cooperative groups have then come together to provide the rational for adjuvant radiotherapy, reinforced by recent technical developments limiting toxicity, and to develop prospective studies to reduce the risk of relapse. The aim of this critical literature review is to provide an overview of the elements in favor of adjuvant radiation for patients treated for muscle-invasive bladder cancer.
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Affiliation(s)
- P Sargos
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - S Larré
- Service d'urologie, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - O Chapet
- Département de radiothérapie, CHU Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - I Latorzeff
- Département de radiothérapie, groupe Oncorad Garonne, clinique Pasteur, bâtiment Atrium, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
| | - A Fléchon
- Département d'oncologie médicale, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - G Roubaud
- Département d'oncologie médicale, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - M Orré
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - S Belhomme
- Département de physique médicale, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Richaud
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
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18
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Sargos P, Baumann BC, Eapen LJ, Bahl A, Murthy V, Roubaud G, Orré M, Efstathiou JA, Shariat S, Larré S, Richaud P, Christodouleas JP. Adjuvant radiotherapy for pathological high-risk muscle invasive bladder cancer: time to reconsider? Transl Androl Urol 2016; 5:702-710. [PMID: 27785427 PMCID: PMC5071208 DOI: 10.21037/tau.2016.08.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Radical cystectomy with extended pelvic lymph-node dissection, associated with neo-adjuvant chemotherapy, remains the standard of care for advanced, non-metastatic muscle-invasive bladder cancer (MIBC). Loco-regional control is a key factor in the outcome of patients since it is related to overall survival (OS), disease-free survival (DFS) and cause-specific survival. The risk of loco-regional recurrence (LRR) is correlated to pathological factors as well as the extent of the lymphadenectomy. In addition, neither pre- nor post-operative chemotherapy have shown a clear impact on LRR-free survival. Several recent publications have led to the development of a nomogram predicting the risk of LRR, in order to identify patients most likely to benefit from adjuvant radiotherapy. Given the high risk of LRR for selected patients and improvements in radiation techniques that can reduce toxicity, there is a growing interest in adjuvant radiotherapy; international cooperative groups have come together to provide the rationale in favor of adjuvant radiotherapy. Clinical trials in order to reduce the risk of pelvic relapse are opened based on this optimizing patient selection. The aim of this critical literature review is to provide an overview of the rationale supporting the studies of adjuvant radiation for patients with pathologic high-risk MIBC.
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Affiliation(s)
- Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Brian C Baumann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Libni J Eapen
- Department of Radiation Oncology, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amit Bahl
- Department of Radiation Oncology, University Hospitals Bristol, Bristol, UK
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Mathieu Orré
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Stephane Larré
- Department of Urology, Reims University Hospital, Reims, France
| | - Pierre Richaud
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - John P Christodouleas
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
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19
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Gerardi MA, Jereczek-Fossa BA, Zerini D, Surgo A, Dicuonzo S, Spoto R, Fodor C, Verri E, Rocca MC, Nolè F, Muto M, Ferro M, Musi G, Bottero D, Matei DV, De Cobelli O, Orecchia R. Bladder preservation in non-metastatic muscle-invasive bladder cancer (MIBC): a single-institution experience. Ecancermedicalscience 2016; 10:657. [PMID: 27563352 PMCID: PMC4970626 DOI: 10.3332/ecancer.2016.657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of this study is to access the feasibility, toxicity profile, and tumour outcome of an organ preservation curative approach in non-metastatic muscle-invasive bladder cancer. A retrospective analysis was conducted on patients affected by M0 bladder cancer, who refused cystectomy and were treated with a curative approach. The standard bladder preservation scheme included maximal transurethral resection of bladder tumour (TURBT) and combination of radiotherapy and platin-based chemotherapy, followed by endoscopic evaluation, urine cytology, and instrumental evaluation. Thirteen patients fulfilled the inclusion criteria. TNM stage was cT2cN0M0 and cT2cNxM0, in 12 and one patients, respectively. All patients had transitional cell cancer. Twelve patients completed the whole therapeutic programme (a bimodal treatment without chemotherapy for one patient). Median follow-up is 36 months. None of the patients developed severe urinary or intestinal acute toxicity. In 10 patients with a follow-up > 6 months, no cases of severe late toxicity were observed. Response evaluated in 12 patients included complete response and stable disease in 11 patients (92%), and one patient (8%), respectively. At the time of data analysis (March 2016), 10 patients (77%) are alive with no evidence of disease, two patients (15%) died for other reasons, and one patient has suspicious persistent local disease. The trimodality approach, including maximal TURBT, radiotherapy, and chemotherapy for muscle-invasive bladder cancer, is well-tolerated and might be considered a valid and feasible option in fit patients who refuse radical cystectomy.
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Affiliation(s)
- Marianna A Gerardi
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Alessia Surgo
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Samantha Dicuonzo
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ruggero Spoto
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Cristiana Fodor
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Elena Verri
- Medical Division of Urogenital Tumours, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Maria Cossu Rocca
- Medical Division of Urogenital Tumours, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Franco Nolè
- Medical Division of Urogenital Tumours, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Matteo Muto
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Matteo Ferro
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Gennaro Musi
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Danilo Bottero
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Deliu V Matei
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Roberto Orecchia
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
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20
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Abstract
The standard treatment for muscle invasive bladder cancer (MIBC) has been considered to be radical cystectomy (RC) with pelvic lymphadenectomy. However morbidity and impact on quality of life is significant. Radiotherapy has been used in MIBC patients who choose bladder preservation or who are unfit for RC with comparable outcomes. Evidence from some prospective and large retrospective series supports the use of radiotherapy as an attractive alternative option. In this paper we review the evidence and practice of bladder preservation strategies with radiotherapy for muscle invasive bladder cancer.
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Affiliation(s)
- Arafat Mirza
- The Christie NHS Foundation Trust , Manchester, UK
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; The Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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21
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Collins JW, Adding C, Hosseini A, Nyberg T, Pini G, Dey L, Wiklund PN. Introducing an enhanced recovery programme to an established totally intracorporeal robot-assisted radical cystectomy service. Scand J Urol 2015; 50:39-46. [PMID: 26313582 DOI: 10.3109/21681805.2015.1076514] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. MATERIALS AND METHODS Data were prospectively collected on 221 consecutive patients undergoing totally intracorporeal RARC between December 2003 and May 2014. The ERP was specifically designed to support an evolving RARC service, where increasing proportions of patients requiring radical cystectomy underwent RARC. Patient demographics and outcomes before and after implementation of the ERP were compared. The primary endpoint was length of stay (LOS). Secondary outcomes included age, American Society of Anesthesiologists (ASA) score, preoperative staging, operative time, complications and readmissions. Differences in outcomes between patients before and after implementation of ERP were tested with the Jonckheere-Terpstra trend test and quantile regression with backward selection. RESULTS Following implementation of the ERP, the demographics of the patients (n = 135) changed, with median age increasing from 66 to 70 years (p < 0.01), higher ASA grade (p < 0.001), higher preoperative stage cancer (pT ≥ 2, p < 0.05) and increased likelihood of undergoing an ileal conduit diversion (p < 0.001). Median LOS before ERP was 9 days [interquartile range (IQR) 8-13 days] and after ERP was 8 days (IQR 6-10 days) (p < 0.001). ASA grade and neoadjuvant chemotherapy also affected LOS (p < 0.05 and p < 0.01, respectively). There was no significant difference in 30 day complication rates, readmission rates or 90 day mortality, with 59% experiencing complications before ERP implementation and 57% after implementation. The majority of complications were low grade. CONCLUSIONS Patient demographics changed as the RARC service evolved from selected patients to a general service. Despite worsening demographics, LOS decreased following ERP implementation. This evidence-based ERP safely standardized perioperative care, resulting in decreased LOS and decreased variability in LOS.
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Affiliation(s)
- Justin W Collins
- a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden
| | - Christofer Adding
- a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden
| | - Abolfazl Hosseini
- a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden
| | - Tommy Nyberg
- b 2 Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institutet , Stockholm, Sweden
| | - Giovannalberto Pini
- a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden
| | - Linda Dey
- a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden
| | - Peter N Wiklund
- a 1 Department of Urology, Karolinska University Hospital , Stockholm, Sweden
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22
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Baxter E, Dennis K, Kollmannsberger C, Black P, Attwell A, Morris WJ, Tyldesley S. Radical trimodality therapy for patients with locally advanced bladder cancer: The British Columbia Cancer Agency experience. Urol Oncol 2015; 33:66.e13-9. [DOI: 10.1016/j.urolonc.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 11/17/2022]
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23
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Bellefqih S, Khalil J, Mezouri I, ElKacemi H, Kebdani T, Hadadi K, Benjaafar N. [Concomitant chemoradiotherapy for muscle-invasive bladder cancer: current knowledge, controversies and future directions]. Cancer Radiother 2014; 18:779-89. [PMID: 25454383 DOI: 10.1016/j.canrad.2014.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/23/2014] [Accepted: 08/06/2014] [Indexed: 01/04/2023]
Abstract
Radical cystectomy with lymphadenectomy is currently the standard of care for muscle-invasive urothelial bladder cancer; however and because of its morbidity and its impact on quality of life, there is a growing tendency for bladder-sparing strategies. Initially reserved for elderly or unfit patients unable to undergo radical cystectomy, chemoradiotherapy became a true alternative to surgery for highly selected patients. Although there are no randomized trials comparing radical cystectomy with bladder preserving approaches, surgery remains the preferred treatment for many clinicians. Furthermore, comparison is even more difficult as modalities of radiotherapy are not consensual and differ between centers with a variability of protocols, volume of irradiation and type of chemotherapy. Several ongoing trials are attempting to optimize chemoradiotherapy and limit its toxicity, especially through techniques of adaptive radiotherapy or targeted therapies.
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Affiliation(s)
- S Bellefqih
- Service de radiothérapie, Institut national d'oncologie, université Mohammed-V Souissi, avenue Allal-El Fassi, 10100 Rabat, Maroc.
| | - J Khalil
- Service de radiothérapie, Institut national d'oncologie, université Mohammed-V Souissi, avenue Allal-El Fassi, 10100 Rabat, Maroc
| | - I Mezouri
- Service de radiothérapie, Institut national d'oncologie, université Mohammed-V Souissi, avenue Allal-El Fassi, 10100 Rabat, Maroc
| | - H ElKacemi
- Service de radiothérapie, Institut national d'oncologie, université Mohammed-V Souissi, avenue Allal-El Fassi, 10100 Rabat, Maroc
| | - T Kebdani
- Service de radiothérapie, Institut national d'oncologie, université Mohammed-V Souissi, avenue Allal-El Fassi, 10100 Rabat, Maroc
| | - K Hadadi
- Service de radiothérapie, hôpital militaire d'instruction Mohamed-V, 10100 Rabat, Maroc
| | - N Benjaafar
- Service de radiothérapie, Institut national d'oncologie, université Mohammed-V Souissi, avenue Allal-El Fassi, 10100 Rabat, Maroc
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25
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Yuh B, Torrey RR, Ruel NH, Wittig K, Tobis S, Linehan J, Lau CS, Chan KG, Yamzon J, Wilson TG. Intermediate-Term Oncologic Outcomes of Robot-Assisted Radical Cystectomy for Urothelial Carcinoma. J Endourol 2014; 28:939-45. [DOI: 10.1089/end.2014.0073] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bertram Yuh
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Robert R. Torrey
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Nora H. Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kristina Wittig
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Scott Tobis
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer Linehan
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Clayton S. Lau
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kevin G. Chan
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jonathan Yamzon
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Timothy G. Wilson
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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26
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Koga F, Yokoyama M, Fukushima H. Small cell carcinoma of the urinary bladder: a contemporary review with a special focus on bladder-sparing treatments. Expert Rev Anticancer Ther 2014; 13:1269-79. [PMID: 24168010 DOI: 10.1586/14737140.2013.851605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Small cell carcinoma of the urinary bladder (SCCUB) is a rare and aggressive disease. To date, no standard treatment has been proposed due to the lack of prospective studies resulting from the rarity of this disease. Recently published studies of relatively large patient cohorts, however, have shed some light on the management of SCCUB patients. In this article, the authors review the epidemiology, pathogenesis, diagnosis and treatment (based on disease stage), and they then discuss the optimal therapeutic strategy for SCCUB patients, particularly for those with limited, locoregional disease. The authors conclude that multidisciplinary approaches are needed for the optimal management of this aggressive disease. The authors also discuss bladder-sparing approaches for SCCUB patients, compared to those for conventional bladder urothelial carcinoma patients.
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27
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Affiliation(s)
- Jong Chul Park
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Piyush K. Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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28
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Dutton TJ, Daugherty MO, Mason RG, McGrath JS. Implementation of the Exeter Enhanced Recovery Programme for patients undergoing radical cystectomy. BJU Int 2014; 113:719-25. [DOI: 10.1111/bju.12533] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas J. Dutton
- Exeter Surgical Health Services Research Unit; Royal Devon and Exeter NHS Foundation Trust; Exeter UK
| | - Mark O. Daugherty
- Exeter Surgical Health Services Research Unit; Royal Devon and Exeter NHS Foundation Trust; Exeter UK
| | - Robert G. Mason
- Exeter Surgical Health Services Research Unit; Royal Devon and Exeter NHS Foundation Trust; Exeter UK
| | - John S. McGrath
- Exeter Surgical Health Services Research Unit; Royal Devon and Exeter NHS Foundation Trust; Exeter UK
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29
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Zaghloul MS, Gouda I. Schistosomiasis and bladder cancer: similarities and differences from urothelial cancer. Expert Rev Anticancer Ther 2014; 12:753-63. [DOI: 10.1586/era.12.49] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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30
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Zhang ZL, Dong P, Li YH, Liu ZW, Yao K, Han H, Qin ZK, Zhou FJ. Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients. CHINESE JOURNAL OF CANCER 2013; 33:165-71. [PMID: 23958053 PMCID: PMC3966145 DOI: 10.5732/cjc.012.10312] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months (range, 0.2–139.1 months). Thirty-day mortality was (1.4%). The 5-year recurrence-free survival, cancer-specific survival (CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease (81.4% vs. 34.9%, P < 0.001). For the 38 patients (14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis (P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor (98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age (hazard ratio, 2.045; P = 0.013) and T category (hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.
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Affiliation(s)
- Zhi-Ling Zhang
- Department of Urology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China.
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Merseburger AS, Herrmann TRW, Shariat SF, Kyriazis I, Nagele U, Traxer O, Liatsikos EN. EAU guidelines on robotic and single-site surgery in urology. Eur Urol 2013; 64:277-91. [PMID: 23764016 DOI: 10.1016/j.eururo.2013.05.034] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
CONTEXT This is a short version of the European Association of Urology (EAU) guidelines on robotic and single-site surgery in urology, as created in 2013 by the EAU Guidelines Office Panel on Urological Technologies. OBJECTIVE To evaluate current evidence regarding robotic and single-site surgery in urology and to provide clinical recommendations. EVIDENCE ACQUISITION A comprehensive online systematic search of the literature according to Cochrane recommendations was performed in July 2012, identifying data from 1990 to 2012 regarding robotic and single-site surgery in urology. EVIDENCE SYNTHESIS There is a lack of high-quality data on both robotic and single-site surgery for most upper and lower urinary tract operations. Mature evidence including midterm follow-up data exists only for robot-assisted radical prostatectomy. In the absence of high-quality data, the guidelines panel's recommendations were based mostly on the review of low-level evidence and expert opinions. CONCLUSIONS Robot-assisted urologic surgery is an emerging and safe technology for most urologic operations. Further documentation including long-term oncologic and functional outcomes is deemed necessary before definite conclusions can be drawn regarding the superiority or not of robotic assistance compared with the conventional laparoscopic and open approaches. Laparoendoscopic single-site surgery is a novel laparoscopic technique providing a potentially superior cosmetic outcome over conventional laparoscopy. Nevertheless, further advantages offered by this technology are still under discussion and not yet proven. Due to the technically demanding character of the single-site approach, only experienced laparoscopic surgeons should attempt this technique in clinical settings. PATIENT SUMMARY This work represents the shortened version of the 2013 European Association of Urology guidelines on robotic and single-site surgery. The authors systematically evaluated published evidence in these fields and concluded that robotic assisted surgery is possible and safe for most urologic operations. Whilst laparoendoscopic single-site surgery is performed using the fewest incisions, the balance between risk and benefit is currently unclear. The evidence to support the conclusions in this guideline was generally poor, but best for robotic assisted radical prostatectomy. As such, these recommendations were based upon expert opinion, and further high-quality research is needed in this field.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology and Urologic Oncology Medical School of Hanover (MHH), Hanover, Germany.
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Rezaianzadeh A, Mohammadbeigi A, Mobaleghi J, Mohammadsalehi N. Survival analysis of patients with bladder cancer, life table approach. J Midlife Health 2013; 3:88-92. [PMID: 23372326 PMCID: PMC3555033 DOI: 10.4103/0976-7800.104468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Bladder cancer is the fourth most common malignancy in men and the eighth most common in women. It causes 8% of all malignancies in men and 3% of all malignancies in women. The trend of bladder cancer is increasing in Iran. This study was conducted to estimate the survival rate of bladder cancer based on life table method. MATERIALS AND METHODS In this study, at first, data were collected based on individual variables of 514 patients suffering from bladder cancer and referred them to cancer registry center of Shiraz University of Medical Sciences from 2001-2009. Data were collected at two stages and analyzed by life table method and Wilcox on test. Significant level considered at 0.05. RESULTS Our findings showed that probability of survival accumulation at the end of 1, 3, 5, 10 years in patients with bladder cancer were equal to 0.8989, 0.7132, 0.5752 and 0.2459 respectively. There was significant difference in survival rate among age groups and treatment types (P < 0.05). However, we did not observe any difference in survival time based on smoking (P = 0.578), alcohol (P = 0.419) and education level (P = 0.371) of patients. CONCLUSION The overall survival rate of bladder cancer in the present study was less than other areas. Patients' age and treatment type were the influential factor in survival time. So continuous screening for early diagnosis suggested for older people.
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Affiliation(s)
- Abbas Rezaianzadeh
- Research Center for Health Sciences, Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
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Mmeje CO, Martin AD, Nunez-Nateras R, Parker AS, Thiel DD, Castle EP. Cost Analysis of Open Radical Cystectomy Versus Robot-assisted Radical Cystectomy. Curr Urol Rep 2012. [DOI: 10.1007/s11934-012-0292-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zaghloul MS. Bladder cancer and schistosomiasis. J Egypt Natl Canc Inst 2012; 24:151-9. [PMID: 23159285 DOI: 10.1016/j.jnci.2012.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/11/2012] [Accepted: 08/25/2012] [Indexed: 10/27/2022] Open
Abstract
Schistosoma-associated bladder cancer was believed, for several decades, to be a completely unique entity of disease, different from urothelial cancer. This was probably due to its distinct clinicopathologic and demographic features that varied from those of urothelial entity. The carcinogenesis is an extremely complex process resulting from the accumulation of many genetic and epigenetic changes leading to alterations in the cell proliferation regulation process. In bladder cancer, many of these carcinogenic cascades were not fully documented or somewhat conflicting. Inspite of the efforts performed, much is still needed to explore the presence or absence of the carcinogenic difference with a different etiology. The control of schistosomiasis in certain countries and the subsequent decrease in the intensity of infestation showed changing of features approaching that of urothelial tumors. However the schistosoma-associated bladder cancer presented in more advanced stages than schistosoma-non associated urothelial cancer. More recently, data are gathered that, upon applying the same treatment protocol and management care, stage by stage comparison of the treatment end-results were found to be similar in bladder cancer patients with a different etiology. All treatment options; including radical cystectomy with or without adjuvant or neoadjuvant chemo- or radiotherapy or trimodality bladder preserving treatment seem to lead to similar end-results regardless of etiologic factor(s) implicated in bladder cancer development.
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Affiliation(s)
- Mohamed S Zaghloul
- Radiation Oncology Department, Children's Cancer Hospital and National Cancer Institute, Cairo University, Cairo, Egypt.
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Development of a nomogram to predict non-organ-confined bladder urothelial cancer before radical cystectomy. Int Urol Nephrol 2012; 44:1711-9. [DOI: 10.1007/s11255-012-0273-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
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Gondo T, Yoshioka K, Nakagami Y, Okubo H, Hashimoto T, Satake N, Ozu C, Horiguchi Y, Namiki K, Tachibana M. Robotic Versus Open Radical Cystectomy: Prospective Comparison of Perioperative and Pathologic Outcomes in Japan. Jpn J Clin Oncol 2012; 42:625-31. [DOI: 10.1093/jjco/hys062] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mmeje CO, Nunez-Nateras R, Nielsen ME, Pruthi RS, Smith A, Wallen EM, Humphreys MR, Woods ME, Castle EP. Oncologic outcomes for lymph node-positive urothelial carcinoma patients treated with robot assisted radical cystectomy: with mean follow-up of 3.5 years. Urol Oncol 2012; 31:1621-7. [PMID: 22534088 DOI: 10.1016/j.urolonc.2012.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 12/29/2022]
Abstract
PURPOSE Previous studies have shown robot assisted radical cystectomy (RARC) to have comparable perioperative outcomes to open radical cystectomy. There are few reports that have examined the oncologic results of RARC, specifically with respect to lymph node-positive patients. We report the outcomes of pathologic node-positive patients who have undergone RARC with medium-term follow-up. MATERIALS AND METHODS A total of 275 patients underwent RARC at 2 institutions for invasive bladder cancer between April 2005 and June 2009. We examined the 50 patients with lymph node-positive disease. Oncologic outcomes, overall, and recurrence-free survival were analyzed and compared with the open literature. RESULTS Mean (median) clinical follow-up in this cohort was 42 (39.5) months (range 16-75 months). The mean (median) number of lymph nodes (LN) removed was 18 (17.5) (range 5-35), and mean (median) number of positive LN was 3 (2) (range 1-12). Mean lymph node density was 18%. Seventeen (34%) patients had ≤ pT2 disease and 33 (66%) pT3/T4 disease. At this follow-up, 29 patients have recurred, and 22 patients have died of disease. Mean (median) time to recurrence was 10 (9) months. The estimated overall survival at 36 and 60 months was 55%, and 45%, respectively. The recurrence-free survival at 36 and 60 months was 43%, and 39%, respectively. Thirty-three (66%) patients had an LN density <20%. The estimated overall survival at 36 months of patients with a lymph node density of <20% was higher than those with a lymph node density >20%, though the difference was not statistically significant. A total of 58% of patients received chemotherapy in this cohort. The use of chemotherapy was associated with a statistically significant (P = 0.033) improvement in overall survival, with an overall survival of 68% at 36 months compared with 36% for the patients who did not receive any chemotherapy. CONCLUSIONS The oncologic outcomes of patients with lymph node-positive bladder cancer treated with robot assisted radical cystectomy (RARC) compare favorably to previous published studies of open radical cystectomy at medium-term (mean follow-up of 42 months). As our follow-up increases, we expect to continue to accurately define the long-term clinical suitability and oncologic success of this procedure in this high-risk population.
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Koga F, Kihara K. Selective bladder preservation with curative intent for muscle-invasive bladder cancer: a contemporary review. Int J Urol 2012; 19:388-401. [PMID: 22409269 DOI: 10.1111/j.1442-2042.2012.02974.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radical cystectomy plus urinary diversion, the reference standard treatment for muscle-invasive bladder cancer, associates with high complication rates and compromises quality of life as a result of long-term effects on urinary, gastrointestinal and sexual function, and changes in body image. As a society ages, the number of elderly patients unfit for radical cystectomy as a result of comorbidity will increase, and thus the demand for bladder-sparing approaches for muscle-invasive bladder cancer will also inevitably increase. Trimodality bladder-sparing approaches consisting of transurethral resection, chemotherapy and radiotherapy (Σ 55-65 Gy) yield overall survival rates comparable with those of radical cystectomy series (50-70% at 5 years), while preserving the native bladder in 40-60% of muscle-invasive bladder cancer patients, contributing to an improvement in quality of life for such patients. Limitations of the trimodality therapy include (i) muscle-invasive bladder cancer recurrence in the preserved bladder, which most often arises in the original muscle-invasive bladder cancer site; (ii) potential lack of curative intervention for regional lymph nodes; and (iii) increased morbidity in the event of salvage radical cystectomy for remaining or recurrent disease as a result of high-dose pelvic irradiation. Consolidative partial cystectomy with pelvic lymph node dissection followed by induction chemoradiotherapy at lower dose (e.g. 40 Gy) is a rational strategy for overcoming such limitations by strengthening locoregional control and reducing radiation dosage. Molecular profiling of the tumor and functional imaging might play important roles in optimal patient selection for bladder preservation. Refinement of radiation techniques, intensified concurrent or adjuvant chemotherapy, and novel sensitizers, including molecular targeting agent, are also expected to improve outcomes and consequently provide more muscle-invasive bladder cancer patients with favorable quality of life.
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Affiliation(s)
- Fumitaka Koga
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
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Smith AB, Raynor MC, Pruthi RS. Peri- and postoperative outcomes of robot-assisted radical cystectomy (RARC). BJU Int 2011; 108:969-75. [DOI: 10.1111/j.1464-410x.2011.10456.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin AD, Nunez RN, Castle EP. Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology 2010; 77:621-5. [PMID: 21122900 DOI: 10.1016/j.urology.2010.07.502] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/15/2010] [Accepted: 07/31/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To perform a complete cost analysis comparing robot assisted radical cystectomy (RARC) versus open radical cystectomy (ORC). MATERIAL AND METHODS After institutional review board approval for data collection, we prospectively recorded perioperative outcomes and costs, such as hospital stay, transfusion rate, readmission rate, and medications for consecutive patients undergoing RARC or ORC. Using actual cost data, we developed a cost decision tree model to determine typical perioperative costs for both RARC and ORC. Multivariate sensitivity analysis was performed to elucidate which variables had the greatest impact on overall cost. Breakeven points with ORC were calculated using our model to better evaluate variable influence. In addition to the above modeled analysis, actual patient costs, including complications 30 days from surgery, were also compared for each procedure. RESULTS Our model analysis showed that operative time and length of stay had the greatest impact on perioperative costs. Robotic cystectomy became more expensive than open cystectomy at the following break-even points: operating room (OR) time greater than 361 minutes, length of stay greater than 6.6 days, or robotic OR supply cost exceeding $5853. RARC was 16% more expensive when only comparing direct operative costs. Interestingly, actual total patient costs revealed a 38% cost advantage favoring RARC due to increased hospitalization costs for ORC in our cohort. CONCLUSIONS RARC can provide a cost-effective alternative to ORC with operative time and length of stay being the most critical cost determinants. Higher complication rates with ORC make total actual costs much higher than RARC.
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Affiliation(s)
- Aaron D Martin
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85022, USA.
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Ileal Conduit as the Standard for Urinary Diversion After Radical Cystectomy for Bladder Cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.09.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kauffman EC, Ng CK, Lee MM, Otto BJ, Wang GJ, Scherr DS. Early oncological outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy. BJU Int 2010; 107:628-35. [PMID: 20883479 DOI: 10.1111/j.1464-410x.2010.09577.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eric C Kauffman
- Department of Urology, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA.
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Current world literature. Curr Opin Urol 2010; 20:443-51. [PMID: 20679773 DOI: 10.1097/mou.0b013e32833dde0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Zaghloul MS. Adjuvant and neoadjuvant radiotherapy for bladder cancer: revisited. Future Oncol 2010; 6:1177-91. [DOI: 10.2217/fon.10.82] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
To date, radical cystectomy has continued to be the treatment of choice for muscle-invasive bladder cancer. It is associated with a 5-year disease-free survival rate ranging from 27–55%. This outcome is significantly worse when reporting upon locally advanced cases. The independent prognostic factors include: tumor stage, grade, pelvic nodal involvement and some other additional factors. Beside the higher reported incidence of distant metastasis, local recurrence either alone or combined with systemic relapse has been shown to be experienced by 23–50% of locally advanced patients – a rate that was much more frequent than previously believed. Nonrandomized trials of preoperative radiotherapy have suggested improved survival rates. However, only one out of the six randomized preoperative trials in the literature published in English has proved to be significant. On the other hand, the only randomized trial and most retrospective studies dealing with postoperative radiotherapy revealed a significant increase in disease-free survival. Late complications of post operative radiotherapy, contrary to former belief, were acceptable and generally depended upon the volume of the irradiated normal tissues and the radiotherapy techniques used. Most of these adjuvant or neoadjuvant reports were performed in the 1970s and 1980s using conventional radiation techniques. Modern radiotherapy, delivering higher doses to the tumor while saving a significant amount of the surrounding normal structure, has not been rigorously tested. However, these techniques have already succeeded in improving treatment end results in other pelvic tumors.
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Affiliation(s)
- Mohamed Saad Zaghloul
- Radiation Oncology Department, Children’s Cancer Hospital (57357), Egypt & National Cancer Institute, Cairo University, 1 Sekket El Emam, Sayeda Zainab, Cairo, Egypt
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