Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival

2021 ◽  
Author(s):  
Francesco Claps ◽  
Maaike W. van de Kamp ◽  
Roman Mayr ◽  
Peter J. Bostrom ◽  
Joost L. Boormans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cancer Survival ◽  
Surgical Margins ◽  
Positive Surgical Margins ◽  
Factors Associated

scholarly journals Benchmarking PASADENA Consensus along the Learning Curve of Robotic Radical Cystectomy with Intracorporeal Neobladder: CUSUM Based Assessment

2021 ◽  
Vol 10 (24) ◽  
pp. 5969
Author(s):  
Riccardo Lombardo ◽  
Riccardo Mastroianni ◽  
Gabriele Tuderti ◽  
Mariaconsiglia Ferriero ◽  
Aldo Brassetti ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Learning Curve ◽  
Radical Cystectomy ◽  
Operative Time ◽  
Surgical Margins ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Positive Surgical Margins ◽  
Muscle Invasive

(1) Aim: Robot assisted radical cystectomy (RARC) with intacorporeal neobladder (iN) is a challenging procedure. There is a paucity of reports on RARC-iN, the extracorporeal approach being the most used. The aim of our study was to assess the learning curve of RARC-iN and to test its performance in benchmarking Pasadena consensus outcomes. (2) Material and methods: The single-institution learning curve of RARC-iN was retrospectively evaluated. Demographic, clinical and pathologic data of all patients were recorded. Indications to radical cystectomy included muscle invasive bladder cancer (pT ≥ 2) or recurrent high grade non muscle invasive bladder cancer. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted by the medical field in the 1970s to analyze learning curves for surgical procedures. The learning curve was evaluated using the following criteria: 1. operative time (OT) <5 h; 2. 24-h Hemoglobin (Hb) drop <2 g/dl; 3. severe complications (according to the Clavien classification system) <30%; 4. positive surgical margins <5%; and 5. complete lymph-node dissection defined as more than 16 nodes. Benchmarking of all five items on quintile analysis was tested, and a failure rate <20% for any outcome was set as threshold. (3) Results: the first 100 consecutive RARC-iN patients were included in the analysis. At CUSUM analysis, RARC required 20 cases to achieve a plateau in terms of operative time (defined as more than 3 consecutive procedures below 300 min). Hemoglobin drop, PSM and number of removed lymph-nodes did not change significantly along the learning curve. Overall, 41% of the patients presented at least one complication. Low-grade and high-grade complication rates were 30% and 17%, respectively. When assessing the benchmarks of all five Pasadena consensus outcomes on quintile analysis, a plateau was achieved after the first 60 cases. (4) Conclusions: RARC-iN is a challenging procedure. The potential impact of the learning curve on significant outcomes, such as high grade complications and positive surgical margins, has played a detrimental effect on its widespread adoption. According to this study, in tertiary referral centers, 60 procedures are sufficient to benchmark all outcomes defined in Pasadena RARC consensus.

scholarly journals P0570THE INCIDENCE, RISK FACTORS OF ACUTE KIDNEY DISEASES AND DISORDERS AND ITS IMPACT ON CHRONIC KIDNEY DISEASE IN PATIENTS AFTER RADICAL CYSTECTOMY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shengnan Ge ◽  
Ying Tang ◽  
Junzhe Chen ◽  
Wenjuan Yu ◽  
Anping Xu
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Bladder Cancer ◽  
Kidney Disease ◽  
Radical Cystectomy ◽  
Kidney Diseases ◽  
Operation Time ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Incidence Risk

Abstract Background and Aims Acute kidney injury (AKI) is a widely-discussed complication associated with the radical cystectomy which is the gold standard for the management of invasive bladder cancer. Until now, few studies investigate the new criteria named Acute Kidney Diseases and Disorders(AKD) as the complication of radical cystectomy. In this study, we evaluated the incidence, risk factors of AKD and evaluate its impact on chronic kidney disease (CKD) in patients after radical cystectomy. Method A total of 279 patients who underwent radical cystectomy at Sun Yat-sen Memorial Hospital, Guangzhou, China, from January 2006 to June 2019 were evaluated, including 168 patients for Robotic-assisted Laparoscopic Radical Cystectomy (RLRC) and 111 patients for Laparoscopic Radical Cystectomy(LRC). AKD was diagnosed according to the classification scheme proposed in the 2012 KDIGO guideline. Logistic regression modeling was used to explore risk factors of AKD, while risk factors associated with CKD in AKD patients were investigated using Kaplan-Meier analysis, respectively. Results The overall incidence of AKD after radical cystectomy was 34.1% (95 out of 279) ,the incidences differ significantly between the RLRC and LRC groups (67 [39.9%] vs 28 [25.2%], P=0.011). Among 279 patients, risk factors associated with postoperative AKD included RLRC (OR 2.067, 95%CI 1.188 to 3.595, P=0.010), Age (years) (OR 1.046, 95%CI 1.018 to 1.074, P=0.001), baseline eGFR&lt;60(ml/(min.1.73m2) (OR 2.662, 95%CI 1.355 to 5.230, P=0.004), Further subgroup analysis identified age, operation time&lt;250(min) as important risk factors of AKD in RLRC patients but not in LRC patients. Of 211 patients with a preoperative estimated glomerular filtration rate (eGFR) of &gt; 60 ml/min/1.73 m2, CKD developed in 16.0% (21/ 131) of patients in the non-AKD group and 36.3% (29/ 80) of patients in the AKD group. Kaplan-Meier analysis(shown in figure 1) identified that AKD is associated with higher CKD rates in those patients (P &lt;0.001). Conclusion One-third of bladder cancer patients developed AKD after after radical cystectomy. RLRC, Age, baseline eGFR &lt;60(ml/(min.1.73m2) were independent risk factors for postoperative AKD in all patients. Occurance of AKD could increase the risk of new-onset CKD in the long run. Though the use of RLRC is now well established, we should be aware that it may increase the risk of postoperative AKD, especially for patients who are old and with lower eGFR .Besides, we should try to improve the management of those AKD patients with aim toward preventing further development of CKD.

Positive Surgical Margins in Soft Tissue Following Radical Cystectomy for Bladder Cancer and Cancer Specific Survival

2007 ◽  
Vol 178 (6) ◽  
pp. 2308-2313 ◽  
Author(s):  
Zohar A. Dotan ◽  
Kathryn Kavanagh ◽  
Ofer Yossepowitch ◽  
Matt Kaag ◽  
Semra Olgac ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Soft Tissue ◽  
Radical Cystectomy ◽  
Surgical Margins ◽  
Cancer Specific Survival ◽  
Positive Surgical Margins

scholarly journals Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Chaudhry A. Ebad ◽  
Mairead Hamill ◽  
Catalin Constandache ◽  
Cliona Cowhig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Renal Function ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Beaumont Hospital ◽  
Renal Function Decline ◽  
Factors Associated ◽  
Renal Function Deterioration

Abstract Background. Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, renal function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term renal function decline and mortality. Methods. Retrospective study in patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We include patients who had assessment for at least two years post procedure and confirmed live status. We assessed the estimated glomerular filtration rate (eGFR) preoperatively, at first and second year, renal function decline > 10 ml/min/1.73 m2, start dialysis and mortality. Logistic regression analyses were applied to assess risk factors associated, a significant p-value < 0.05 was considered. Results. We included 264 patients, with median age 68.3 years, 73,7% males, main diagnose was bladder cancer 93.3%, TNM stages were grouped in T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73 m2 and after 2 years 58.2 ml/min/1.73 m2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73 m2. Risk factors associated with ESKD included age (HR:1.13, CI95% 1.05–1.22), preoperative eGFR (HR:1.04, CI95% 1.01–1.07). Overall mortality was 43.2%, 75.9% at 5 and 10 years respectively, risk factors were age (HR:1.1, CI95% 1.04–1.18), preoperative eGFR (HR:1.03, CI95% 1.01–1.06) and male gender (HR:14.8, CI95% 1.1–192). Conclusions. Patients with RC have risk of progressive renal function deterioration and high mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of renal function will permit early diagnosis and treatment.

scholarly journals Long-term kidney function and mortality after radical cystectomy and ileal conduit formation.

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Chaudhry A. Ebad ◽  
Mairead Hamill ◽  
Catalin Constandache ◽  
Cliona Cowhig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Kidney Function ◽  
Urinary Diversion ◽  
Factors Associated ◽  
Post Procedure ◽  
Common Diagnosis ◽  
Kidney Function Decline

Abstract Background: Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, kidney function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term kidney function decline and mortality. Methods: Retrospective study of patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We included patients who had follow up data of at least two years post procedure. We assessed the following outcomes: estimated glomerular filtration rate (eGFR) preoperatively, at first and second year post-procedure, kidney function decline >10 ml/min/1.73m 2 , dialysis commencement and mortality. Logistic regression analyses were applied to assess risk factors associated, a p-value <0.05 was considered significant. Results: We included 264 patients, with median age 68.3 years, 73,7% males. The most common diagnosis was bladder cancer 93.3%, TNM stages were grouped in T≥2 75.9%, N≥1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73m 2 and after 2 years 58.2 ml/min/1.73m 2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease >10 ml/min/1.73m 2 . Risk factors associated with ESKD included; age (HR:1.13, CI95% 1.05-1.22), and pre-operative eGFR (HR:1.04, CI95% 1.01-1.07). Overall mortality was 43.2% and 75.9% at 5 and 10 years respectively, risk factors for which were age (HR:1.1, CI95% 1.04-1.18), preoperative eGFR (HR:1.03, CI95% 1.01-1.06) and male gender (HR:14.8, CI95% 1.1-192). Conclusions: Patients with RC are at risk of progressive kidney function deterioration and elevated mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of kidney function will permit early diagnosis and treatment.

1906 POSITIVE SURGICAL MARGINS CONTRIBUTE TO DELAYED FAILURES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Edwin Morales ◽  
Shahrokh Shariat ◽  
Pierre Karakiewicz ◽  
Bjorn Volkmer ◽  
Wassim Kassouf ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Surgical Margins ◽  
Positive Surgical Margins

scholarly journals Re-operation within 30 days of radical cystectomy: Identifying high-risk patients and complications using ACS-NSQIP database

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rashid K. Sayyid ◽  
Diana Magee ◽  
Amanda E. Hird ◽  
Benjamin T. Harper ◽  
Eric Webb ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
African American ◽  
High Risk ◽  
Radical Cystectomy ◽  
High Risk Patients ◽  
Metastatic Bladder Cancer ◽  
Risk Patients ◽  
History Of ◽  
African American Race

Introduction: Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer. Methods: We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation. Results: A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07), African-American race (vs. Caucasian OR 2.29; 95% CI 1.21–4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33; 95% CI 1.45–3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%) with a significantly longer hospital length of stay (16.5 vs. 7.0 days). Conclusions: Recognizing increasing BMI, COPD, and African-American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.

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