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Sowanthip D, Zennami K, Bejrananda T, Nukaya T, Takenaka M, Ichino M, Takahara K, Sasaki H, Kusaka M, Sumitomo M, Shiroki R. Older versus younger patients in robot-assisted radical cystectomy with intracorporeal ileal conduit comparing safety and clinical outcomes. Int J Urol 2024; 31:370-378. [PMID: 38180102 DOI: 10.1111/iju.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of robot-assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients. METHODS We retrospectively analyzed 122 patients who underwent robot-assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence-free survival, cancer-specific survival, and overall survival were compared between the cohorts. RESULTS The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30-day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence-free survival, cancer-specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer-specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high-grade complications and cancer-specific survival. CONCLUSIONS Robot-assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.
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Affiliation(s)
- Dutsadee Sowanthip
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tanan Bejrananda
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Matsukawa A, Morizane S, Shimizu R, Teraoka S, Nishikawa R, Yamaguchi N, Iwamoto H, Hikita K, Honda M, Nonomura N, Takenaka A. Chronic kidney disease and Charlson comorbidity index predict complications after robot-assisted radical cystectomy: A single-center study in Japan. Int J Urol 2024; 31:231-237. [PMID: 37950530 DOI: 10.1111/iju.15337] [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: 03/13/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To investigate preoperative patient factors that may predict the occurrence of perioperative complications following robot-assisted radical cystectomy at a single center in Japan. METHODS From 2013 to 2022, 103 patients underwent RARC at our institution. Complications within 90 days after surgery were assessed using the Clavien-Dindo classification. Preoperative characteristics and surgical outcomes were compared between cohorts with and without complications ≥grade 3. Logistic regression analysis was used to identify the risk factors associated with perioperative complications. RESULTS Overall, 27% of patients (27/103) experienced grade 3 or higher complications. The cohort that developed complications ≥grade 3 exhibited significantly higher Charlson comorbidity index (p = 0.046) and significantly lower estimated glomerular filtration rate (p = 0.048). Charlson comorbidity index ≥2 (p = 0.037) and estimated glomerular filtration rate <53 (p = 0.008) were independent predictors for the occurrence of complications ≥grade 3. The incidence of complications ≥grade 3 was 61.5% in the group possessing both factors, which was significantly higher than those in the groups possessing neither factor nor only one of the two factors. CONCLUSIONS Our results suggest that the Charlson comorbidity index and preoperative estimated glomerular filtration rate may be predictors of perioperative complications. It is important to evaluate the patient's preoperative characteristics and choose the surgical procedure accordingly.
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Affiliation(s)
- Atsuki Matsukawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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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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Chen W, Yokoyama M, Waseda Y, Kobayashi M, Fan B, Fukuda S, Tanaka H, Yoshida S, Ai M, Fushimi K, Fujii Y. Surgical outcomes of robot-assisted radical cystectomy in octogenarian or older patients: A Japanese nationwide study. Int J Urol 2023; 30:1014-1019. [PMID: 37470427 DOI: 10.1111/iju.15250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To evaluate the surgical outcomes of robot-assisted radical cystectomy (RARC) in octogenarian or older patients based on a Japanese nationwide database. METHODS The diagnosis procedure combination database was used to extract the data on radical cystectomy cases. Surgical outcomes of RARC in octogenarian or older patients (older group) were initially compared to those of patients younger than 80 years (younger group). Then, the surgical outcomes of RARC in the older group were compared to those of open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) in the same age group. RESULTS Between 2018 and 2021, 478 RARC cases in the older group and 2257 RARC cases in the younger group were identified. In the older group, ileal conduit, neobladder, and other urinary diversions were carried out in 352 (73.6%), 22 (4.6%), and 104 (21.8%) patients, respectively. In the older group, when compared with the younger group, the complication rate (24.9%), blood transfusion rate (41.4%), and in-hospital mortality (1.4%) were equivalent, while significantly shorter anesthesia time and longer length of stay were observed in the older group (521.0 ± 140.4 min vs. 595.1 ± 141.71 min, p < 0.01, and 32.9 ± 16.8 days vs. 30.6 ± 17.8 days, p = 0.01, respectively). In the comparison of the surgical outcomes of older patients receiving RARC to those receiving ORC (n = 746) and LRC (n = 375), the RARC group had the lowest complication rate and the shortest length of stay, while the shortest anesthesia time was noted in the ORC group. CONCLUSION The feasibility of RARC for octogenarian or older patients was demonstrated by the nationwide database study.
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Affiliation(s)
- Wei Chen
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bo Fan
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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