Surgical safety in radical cystectomy: the anesthetist's point of view—how to make a safe procedure safer

2019 ◽  
Vol 38 (6) ◽  
pp. 1359-1368 ◽  
Author(s):  
Dominique Engel ◽  
Marc A. Furrer ◽  
Patrick Y. Wuethrich ◽  
Lukas M. Löffel
2021 ◽  
pp. 29-31
Author(s):  
Kulwant Singh Bhau ◽  
Iqbal Saleem Mir ◽  
Mufti Mahmood Ahmad

Background: Gastro-intestinal stromal tumour (GIST) commonly involves stomach. Recently there has been an inclination towards managing these benign but potentially malignant lesions by minimal invasive techniques. Surgical excision of gastric GIST mostly requires anterior wall gastrostomy especially for intraluminal lesions. The size and location of the lesion are critical from technical point of view. Lesions located at gastro-esophageal junction requires larger anterior gastric wall opening to reach the site of tumour for excision. Endoscopic excision for such lesions is not always amenable. We performed excision of a posteriorly locat Methods: ed gastric GIST at GE junction by hitching the anterior gastric wall with the anterior abdominal wall and by directly creating pneumogastrium percutaneously for placing three intra-gastric trocars. Results: Patient was discharged on post-operative day 3 in a satisfactory condition. Histopathology revealed complete resection of GIST lesion with margins free from tumour. Immuno-histochemistry (IHC) conrmed it to be GIST with low malignant potential and patient was advised regular follow up. Laparoscopic intra-gastric excision of a posteriorly located gast Conclusion: ro-oesophageal junction GIST lesion after creating pneumogastrium and using conventional laparoscopic instruments is a safe procedure


Author(s):  
Maliikarjuna Gurram ◽  
Ravichander G. ◽  
Ravi Jahagidar ◽  
Vinay Reddy

Background: Radical cystectomy with pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. With the advent of improved surgical techniques and postoperative management, the complications and mortality rates have reduced. The present study was done to analyse the perioperative, early and late compilations following radical cystectomy for bladder tumor.Methods: This is a prospective observational study of patients who underwent radical cystectomy for invasive bladder tumor from February 2016 to November 2017. Radical cystectomy was done through midline transperitoneal approach.  Urinary diversion was done by ileal conduit. All patients were followed at 6th week, 3rd month, 6th month, and at 1 year.Results: Total 21 patients underwent radical cystectomy, 17(80.95%) were males and 4 (19.04%) females. The median age was 60 years, ranging from 40 to 73 years. The   most common age group was 60 to 75 years (52.3%). Thirteen (61.9%) patients were smokers and all were males. Painless haematuria alone was most common presentation (of bladder tumor) seen in 15 (71.4%) patients. Early complications were seen in 8 (38.09%) patients, most common early complication was urinary leak 2 (9.5%) patents, other early complications were bowel leak, wound dehiscence, pelvic collection, burst abdomen, prolonged ileus, subacute intestinal obstruction, acute kidney injury and sepsis seen in one (4.25%) patient each. Late complications were seen in 4 (19.04%) patients.  Pelvic recurrence was the most common late complication seen in 2 (9.55%) patients. Ureteric stricture was seen in one patient (4.75%) for which percutaneous nephrostomy and antegrade DJ stenting was done. Among the histopathological variants of tumor 20 (95.25%) patients had high grade variants and only one (4.75%) had low grade papillary urothelial carcinoma. Among the high grade variants most common pathology was urothelial carcinoma in 17 (80.9%) patients.Conclusions: Radical cystectomy remains the main stay of treatment in muscle-invasive bladder cancer. This is relatively safe procedure with minimal morbidity and mortality.


2020 ◽  
Vol 2 ◽  
pp. 1-1
Author(s):  
Sebastian Specht ◽  
Bernd Kramer

Abstract. Statistical data on demography is the basis for many population-related scientific questions, economic questions of health care and questions of planning public services. Population data in equal-area cartographic grid cells appears to be a good basis, especially for use cases in inter-municipal contexts of administration and planning (Specht et al. 2019). Census results have been used, since the 2011 census made available small-scale population data for the entire Federal Republic of Germany on a 100m grid for the first time. Unfortunately, this data is not updated by the statistical offices.This presentation describes a use case of demographic grids implemented in a context of inter-municipal cooperation in the region of Bremen. As the calculation of population forecasts was an objective, small-scale data on migration was required. Similar to the approach in the census, demographic data and data on migration are recorded in the residents' registration offices (EMA) of the cooperating municipalities. However, since outside the census other legal frameworks apply, the process cannot be adopted as is. In the EMAs, individual-related micro-data are available, serving as a base file. Under the respective legal framework, the data is anonymised, geo coded and converted into an aggregated tabular form on site.Aggregated data may still contain individual cases worthy of protection. The higher the number of queried characteristics (region, gender, age, nationality etc.) and their differentiation (100m grid or 1km grid, age years or age groups, etc.), the higher the probability to encounter such cases. A number of procedures for statistical disclosure control are available, of which the SAFE procedure (Höhne 2015) (used in the 2011 census) is currently implemented in the project. As other methods or strategies are up for consideration, how can they be evaluated in a specific regional context? From the perspective of confidentiality, space is at first just one feature dimension among others, although there are approaches that explicitly take spatial interrelation into account (Young, Martin, and Skinner 2009).From a geographical point of view, however, high resolution data, especially in sparsely populated areas, can generally be expected to show high before-and-after deviations as a result of confidentiality procedures. Depending on the subject matter, these spatial errors can have different degrees of relevance and thus be ultimately relevant for the selection of the confidentiality strategy. To support a decidedly spatial comparison of the effects of different classification, aggregation and confidentiality strategies, a set of indicators together with an interactive visualization for the project area under consideration is presented for discussion.


2018 ◽  
Vol 36 (6_suppl) ◽  
pp. TPS533-TPS533 ◽  
Author(s):  
Andrea Necchi ◽  
Alberto Briganti ◽  
Daniele Raggi ◽  
Patrizia Giannatempo ◽  
Luigi Mariani ◽  
...  

TPS533 Background: MIUC is an aggressive disease and > 40% of patients (pts) will develop recurrence after radical cystectomy (RC). Despite cisplatin-based neoadjuvant chemotherapy yields Level 1 evidence, it is administered in a minority of pts worldwide. Pembro is an EMA and FDA-approved standard therapy for metastatic UC after platinum failure or for cisplatin-ineligible pts. Our hypothesis was that pembro, given neoadjuvantly, could downstage MIUC and reduce recurrence. Methods: PURE-01 (NCT02736266) is an open-label, single-arm, phase 2 study to evaluate the activity, medical and surgical safety, and immune modulatory effects of pembro administered as a short window-of-opportunity course of therapy preceding RC. Eligibility criteria included: T2-T4aN0 stage, and residual disease after transurethral resection of the bladder (TURB, surgical opinion, cystoscopy or radiological presence). The study includes cisplatin eligible- and ineligible pts. Pts receive 3 cycles of pembro 200mg 3 weekly before RC (planned < 3 weeks of the last dose). Computed tomography (CT) scan, FDG-PET/CT scan, and bladder multiparametric magnetic resonance imaging (mpMRI) are done during screening and before RC. Radiologically non responders to pembro (per investigator decision; i.e., study failures) are given 3 additional courses of dose-dense MVAC chemotherapy. After RC, pts are managed according to local guidelines (adjuvant chemotherapy vs observation). Further anti PD-1/PD-L1 therapy will not be given post-operatively. Pathologic complete response (pT0) is the primary endpoint. All pts enrolled who receive at least 1 cycle of study drug will be included in the ITT analysis. The H1 is pT0 ≥20% and H0 pT0≤10%. In a 2-stage design, 90 pts overall will be accrued (80% power and a 2-sided test of significance at the 10% level). A first interim analysis for safety is planned after 18 patients enrolled and treated (by December 1st, 2017). Activity results and early translational findings (immune-cell profiling) will be added, and may be regarded to as first data of preoperative immunotherapy before major surgery. Clinical trial information: NCT02736266.


2021 ◽  
Vol 62 (7) ◽  
pp. 569
Author(s):  
Hyun Ju Kim ◽  
Jaehee Chun ◽  
Tae Hyung Kim ◽  
Gowoon Yang ◽  
Sang Joon Shin ◽  
...  

2021 ◽  
Vol 8 ◽  
Author(s):  
Katharina Vogt ◽  
Christopher Netsch ◽  
Benedikt Becker ◽  
Sebastian Oye ◽  
Andreas J. Gross ◽  
...  

Purpose: So far, it has not been described whether the perioperative course and the pathologic outcome of patients who undergo radical cystectomy (RC) with orthotopic bladder substitution differs if nerve sparing (NS) is performed or not.Material and Methods: In all, there were 472 patients who underwent RC between 2012 and 2019 at our department. We performed a retrospective analysis of 116 patients who underwent RC with ileal neobladder. We analyzed perioperative complications according to the Clavien–Dindo classification system, as well as the pathological outcome.Results: Of 116 patients, 68 (58.6%) underwent RC, and 48 (41.4%) underwent NS RC. Clavien–Dindo complications ≥3b occurred in 15 (12.9%) of all patients. Only infectious complications differed among the groups [NS RC: 25 patients (52.1%) vs. RC: 20 patients (29.4%); p = 0.02]. There was no significant difference concerning tumor stage. Concomitant Cis was present in 24 patients (35.3%) of the RC group and in 27 patients (56.3%) of the NS RC group (p = 0.036). Nodal status and positive surgical margin status of the bladder tumor did not differ among the groups. In all, 42 of all male patients (45.7%) had an incidental prostatic carcinoma. Positive surgical margins concerning the prostate carcinoma occurred in six patients, with all cases in the RC group (p = 0.029).Conclusions: Our data suggest that performing NS during RC in carefully selected patients is a safe procedure and does not impair perioperative outcome. Pathological outcome of NS RC is comparable as well.


2007 ◽  
Vol 54 (4) ◽  
pp. 63-67 ◽  
Author(s):  
T. Pejcic ◽  
J. Hadzi-Djokic ◽  
M. Acimovic ◽  
B.B. Markovic ◽  
H.M. Maksimovic ◽  
...  

Objective: To present the local recurrence rates after radical cystectomy for advanced bladder cancer and to compare them between patients with orthotopic neobladder and ileal conduit. Patients and methods: 97 patients with radical cystectomy were analyzed: 75 patients with orthotopic ileal neobladder, operated from 1985. to 2006, and 22 patients with ileal conduit, operated from 2000. to 2006. Results: Overall recurrence rate was 41.3% in the neobladder group, and 50% in the ileal conduit group. The rate of pelvic, upper urinary tract and urethral recurrence was 13.3%, 8%, and 10.6% in the neobladder group, and 9.1%, 13.6% and 9.1% in the ileal conduit group. Conclusion: Comparable recurrence rates, operative time, the complexity of the surgical technique and the results between two groups, strongly support the construction of orthotopic neobladder, as superior in functional, esthetic, and psychological point of view.


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