Radical cystectomy vs. multimodality treatment in T2N0M0 bladder cancer: a population-based, age-matched analysis

311 Background: The adoption of the da Vinci Surgical System (Intuitive Surgical, Inc.) for robotic surgery requires a substantial financial investment by hospitals, acquisition of new surgical skills by surgeons, and demand from patients. Although the benefits of this technology have been previously described, the prevalence and adoption rate for robotics in the management of bladder cancer is not currently known. We performed a population-based analysis to determine how the introduction of robotic technology has altered the surgical management of bladder cancer. Methods: We analyzed patient-level data from the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the United States. We captured all patients who underwent a radical cystectomy with a diagnosis of bladder cancer between January 1, 2003, and December 31, 2010, based on codes from the International Classification of Disease, 9th edition. Radical cystectomies utilizing the da Vinci Surgical System were identified by a detailed review of the hospital charge data. Results: There was an increase in an overall adoption of robotic radical cystectomy from <2% in 2003 to 23% in 2010. Since 2005, teaching hospitals had a relative increased utilization of robotic radical cystectomy by approximately 40% each year compared to non-teaching hospitals. Hospitals in the West had the highest odds (odds ratio [OR] 3.1, p<0.001 [vs Midwest]) of utilizing robotic surgery for radical cystectomy while larger hospitals (>200 beds) were more likely to adopt robotic technology for radical cystectomy (OR 1.78, p<0.0001). Conclusions: There has been a relatively rapid adoption of the da Vinci Surgical System in the performance of radical cystectomy. This increased utilization is potentially secondary to the acquisition of robotic surgical skills and familiarity with transperitoneal pelvic anatomy following the widespread use of robotic technology for radical prostatectomy during the same time period.

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Utilization and outcomes of chemoprophylaxis for the prevention of venous thromboembolism following radical cystectomy: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.491 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 491-491

Author(s):

Stephen Reese ◽

Matthew Mossanen ◽

Dimitar V. Zlatev ◽

Daniel Pucheril ◽

Benjamin I. Chung ◽

...

Keyword(s):

Bladder Cancer ◽

Venous Thromboembolism ◽

Radical Cystectomy ◽

Population Based ◽

Charlson Comorbidity Index Score ◽

Included Patient ◽

Increased Risk ◽

American Society ◽

American Urological Association ◽

Cancer Network

491 Background: Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major preventable source of postoperative complications. The risk of VTE in patients undergoing radical cystectomy (RC) for bladder cancer has been estimated at 6%, and the American Society of Clinical Oncology, American Urological Association, and National Comprehensive Cancer Network all recommend perioperative chemoprophylaxis. We performed a population-based analysis to determine the utilization of chemoprophylaxis against VTE in patients undergoing RC. Methods: Using the Premier Hospital Database (Premier, Inc., Charlotte, NC), we retrospectively identified patients who underwent RC for bladder cancer in the US between 2006 and 2015. Administration of chemoprophylaxis within 24 hours of surgery was deemed consistent with recommendations. A subgroup analysis of higher volume hospitals (³10 RC annually) compared outcomes of DVT, PE, and bleeding between patients in hospitals with uniform use versus no use of chemoprophylaxis. Multivariate analysis was used to evaluate predictors of under-utilization of chemoprophylaxis. Results: Among the cohort of 9,133 patients (48,714 patients after weighting adjustment) undergoing RC, 35.1% were administered recommended chemoprophylaxis, with an increase in utilization from 20.7% in 2006 to 49.6% in 2015. Characteristics associated with decreased likelihood of chemoprophylaxis administration included patient age ≥65 years, Charlson Comorbidity Index score ≥2, rural hospital location, commercial insurance, and year of surgery prior to 2010. Patients who received recommended chemoprophylaxis had significantly lower rates of VTE (5.1% vs 6.0%) and PE (2.0% vs 3.1%), but elevated rates of bleeding (12.8% vs 7.7%). Conclusions: The recommended utilization of chemoprophylaxis in a contemporary nationwide cohort of patients undergoing RC is limited despite its notable increase over the course of the study period. Greater compliance with recommended use of chemoprophylaxis following RC may be associated with decreased risk of PE and VTE, but also with increased risk of bleeding.

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667 BLADDER CANCER STAGE DISTRIBUTION AT RADICAL CYSTECTOMY IN THE LAST TWO DECADES IN A POPULATION-BASED COHORT

European Urology Supplements ◽

10.1016/s1569-9056(09)60662-x ◽

2009 ◽

Vol 8 (4) ◽

pp. 287

Author(s):

C. Jeldres ◽

N. Bhojani ◽

S. Baillargeon-Gagné ◽

H. Isbarn ◽

U. Capitanio ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Population Based ◽

Cancer Stage ◽

Stage Distribution

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MP2-03 RADICAL CYSTECTOMY AND ADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER IN THE ELDERLY: A POPULATION-BASED STUDY

The Journal of Urology ◽

10.1016/j.juro.2014.02.161 ◽

2014 ◽

Vol 191 (4S) ◽

Author(s):

Michael Leveridge ◽

Robert Siemens ◽

William Mackillop ◽

Yingwei Peng ◽

David Berman ◽

...

Keyword(s):

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Radical Cystectomy ◽

The Elderly ◽

Population Based ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Population Based Study ◽

Muscle Invasive

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Population-based trends in urinary diversion among patients undergoing radical cystectomy for bladder cancer

BJU International ◽

10.1111/j.1464-410x.2012.11508.x ◽

2013 ◽

Vol 112 (4) ◽

pp. 478-484 ◽

Cited By ~ 41

Author(s):

Simon P. Kim ◽

Nilay D. Shah ◽

Christopher J. Weight ◽

R. Houston Thompson ◽

Jeffrey K. Wang ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Population Based

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Bladder Cancer to Patients Younger than 30 Years: A Retrospective Study and Review of the Literature

Urologia Journal ◽

10.5301/uj.5000264 ◽

2017 ◽

Vol 84 (4) ◽

pp. 231-235 ◽

Cited By ~ 2

Author(s):

Ioannis Katafigiotis ◽

Stavros Sfoungaristos ◽

Alberto Martini ◽

Konstantinos Stravodimos ◽

Ioannis Anastasiou ◽

...

Keyword(s):

Bladder Cancer ◽

Risk Factor ◽

Retrospective Study ◽

Radical Cystectomy ◽

Young Patients ◽

Multimodality Treatment ◽

Urinary Cytology ◽

Macroscopic Hematuria ◽

Multiple Recurrences

Objectives The aim of this report was to study the specific characteristics of bladder cancer in patients younger than 30 years. Materials and Methods Five patients with a mean age of 24 ± 2.83 years were included in the study. All patients had painless macroscopic hematuria as the first symptom. Three patients had pTa as a first diagnosis, one had pT1 and one pT2. All the patients had smoking as a risk factor and at least one additional possible risk factor. Results One patient with pTa had an aggressive course and after multiple recurrences was diagnosed with pT2 and refused to be submitted to radical cystectomy and died from the disease even though he received a multimodality treatment. The other two patients with the pTa diagnosis had no recurrence after the first TUR-BT and the patient with the pT1 diagnosis after one recurrence with a pTa histology is free of recurrence for the last 2 years. The patient diagnosed with pT2 was submitted to a radical cystectomy and an s-pouch diversion with a preservation of the genital system in order to have the ability of a future motherhood with the acceptance of course risks. Conclusions Young patients with bladder cancer is a difficult group of patients and show more reluctance to comply to the necessary strict follow-up of the repeated urinary cytology examinations, cystoscopies and CT pyelographies. Herein, we report a retrospective study of five patients younger than 30 years with bladder cancer.

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