1118: The Incidence and Duration of Postoperative Ileus in Patients Undergoing Radical Cystectomy. A Multivariate Analysis of Contributing Factors

2005 ◽  
Vol 173 (4S) ◽  
pp. 303-303
Author(s):  
Diana Wiessner ◽  
Rainer J. Litz ◽  
Axel R. Heller ◽  
Mitko Georgiev ◽  
Oliver W. Hakenberg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Cystectomy ◽  
Postoperative Ileus ◽  
Contributing Factors

scholarly journals Impact of Lymphovascular Invasion on Prognosis in the Patients with Bladder Cancer—Comparison of Transurethral Resection and Radical Cystectomy

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 244
Author(s):  
Kei Yoneda ◽  
Naoto Kamiya ◽  
Takanobu Utsumi ◽  
Ken Wakai ◽  
Ryo Oka ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Cystectomy ◽  
Transurethral Resection ◽  
Lymphovascular Invasion ◽  
Medical Center ◽  
Univariate Analysis ◽  
The Other ◽  
Significant Prognostic Factor ◽  
Cancer Specific Survival ◽  
Positive Results

(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p < 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

Multivariate Analysis on Risk Factors for Postoperative Ileus After Lateral Lumbar Interbody Fusion

Spine ◽  
2014 ◽  
Vol 39 (8) ◽  
pp. 688-694 ◽  
Author(s):  
Motasem A. Al Maaieh ◽  
Jerry Y. Du ◽  
Alexander Aichmair ◽  
Russel C. Huang ◽  
Alexander P. Hughes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Postoperative Ileus ◽  
Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion

Epidural analgesia is associated with earlier gastrointestinal transit after radical cystectomy but does not reduce the incidence of postoperative ileus: A retrospective cohort study

2021 ◽  
pp. 205141582110515
Author(s):  
Julian Knoerlein ◽  
Sebastian Heinrich ◽  
Kai Kaufmann ◽  
Wolfgang Schultze-Seemann ◽  
Wolfgang Baar ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Radical Cystectomy ◽  
Postoperative Ileus ◽  
Medical Center ◽  
Gastrointestinal Transit ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
Time Required ◽  
First 90 Days

Objective: To compare the effect of combined epidural thoracic analgesia and general anaesthesia (CEGA) in radical cystectomy (RC) with respect to the return of gastrointestinal passage, the incidence of paralytic postoperative ileus (POI) compared to general anaesthesia (GA) only. Patients and methods: We conducted a retrospective review using the electronic medical records of 236 patients who underwent RCs between July 2011 and September 2018 at the Medical Center – University of Freiburg. Results: A CEGA was administered to 202 patients, while 34 patients received only GA. The baseline characteristics of patients with and without CEGA showed no significant differences. CEGA will decrease the time required for return of gastrointestinal transit as measured by time to first defecation by about 13 hours. In the first 90 days after surgery, 82 (34.7%) patients had a POI. There was no significant difference between complications in the CEGA and GA groups. Conclusion: A CEGA accelerates the return of the gastrointestinal transit but does not reduce the incidence of postoperative ileus. Level of evidence: 2b

scholarly journals Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Yasuhiko Hirose ◽  
Taku Naiki ◽  
Ryosuke Ando ◽  
Akihiro Nakane ◽  
Toshiki Etani ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Radical Cystectomy ◽  
Dead Space ◽  
Odds Ratio ◽  
Wound Dressing ◽  
Subcutaneous Fat ◽  
Surgical Site Infections ◽  
New Method ◽  
Site Infection

To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat.

1257 RISK FACTORS AND FREQUENCY OF POSTOPERATIVE ILEUS AND TOTAL PARENTAL NUTRITION AFTER RADICAL CYSTECTOMY

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Amanda Chi ◽  
Dae Y. Kim ◽  
Hari Sawkar ◽  
D. Joseph Thum ◽  
Marc A. Bjurlin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Postoperative Ileus ◽  
Parental Nutrition

scholarly journals Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

2020 ◽  
Vol 38 (12) ◽  
pp. 3139-3153 ◽  
Author(s):  
F. Wessels ◽  
M. Lenhart ◽  
K. F. Kowalewski ◽  
V. Braun ◽  
T. Terboven ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Radical Cystectomy ◽  
Readmission Rate ◽  
Postoperative Ileus ◽  
Meta Analysis ◽  
Fluid Management ◽  
Early Mobilization ◽  
Cochrane Library ◽  
Gum Chewing ◽  
Significant Difference

Abstract Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61–0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52–1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

Association of time delays to radical cystectomy by use of neoadjuvant chemotherapy with higher rates of progression.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 345-345 ◽  
Author(s):  
William P. Parker ◽  
Avinash Nehra ◽  
Joshua Griffin ◽  
Ernesto Lopez-Corona ◽  
Jeffrey M. Holzbeierlein
Keyword(s):  
Multivariate Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Time Delays ◽  
Initial Diagnosis ◽  
Nodal Status ◽  
Time Interval ◽  
Cancer Specific Survival ◽  
Pathologic Stage ◽  
Muscle Invasive

345 Background: Neoadjuvant chemotherapy (NC) is utilized to improve survival for patients with muscle invasive bladder cancer. However, this results in a protracted treatment course of 3−4 chemotherapy cycles given over several months. Previous series have suggested that delays in radical cystectomy (RC) from initial diagnosis are associated with inferior survival rates. We investigated if similar trends are seen in a population of patients treated with neoadjuvant chemotherapy. Methods: A retrospective review of our RC database was performed to identify patients treated with NC over the last five years. Time interval was calculated from date of initial diagnosis of muscle invasive disease to date of surgery. Kaplan Meier and multivariate analysis methods were used to assess recurrence free and cancer specific survival based on pathologic stage, nodal status, margin status, and time to RC with estimation of hazard ratios for those variables. Results: 72 patients from 2006−2012 were identified. Mean age was 64 years and 80% were male. 79% of the cohort had 3 or more cycles of NC, with gemcitabine−cisplatin as the most common regimen (75%). Mean time from diagnosis to RC was 173 days. Pathologic stage distribution was T2−20.8%, T3−20.8%, T4− 18.1% and T0 status was obtained in 27.8%. 95% was of pure urothelial carcinoma histology. Node positive disease was found in 30%. At most recent follow up 33% of the cohort had died and 13% had recurrent disease. Higher tumor stage and positive nodal status were associated with lower recurrence free and cancer specific survival. When stratifying the cohort by time to RC (1−4 months, 5months, 6 months) there was no statistical difference in recurrence free or cancer specific survival. However, on multivariate analysis patients who had RC less than 5 months from diagnosis had lower rates of progression (OR 0.14; 95% CI .02−.08, p 0.038) compared to those with RC after 5 months (OR 4.86 95% CI 0.9−26, p 0.06). Conclusions: Time delays associated with use of NC of greater than five months correlated with lower recurrence free survival in our cohort but there did not appear to be any effect on cancer specific survival. This should be further validated with a larger multicenter analysis.

Determining the optimal timing for radical cystectomy after neoadjuvant chemotherapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 339-339
Author(s):  
Chinedu O. Mmeje ◽  
Cooper Benson ◽  
Graciela M. Nogueras-Gonzalez ◽  
Isuru Sampath Jayaratna ◽  
Neema Navai ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Major Complication ◽  
Complication Rates ◽  
Surgical Time ◽  
Node Metastasis ◽  
Major Complications

339 Background: We present the largest series reviewing complications and pathologic outcomes following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), to determine whether the interval between chemotherapy and surgery (ICS) affects 90-day post-operative morbidity and lymph node metastasis. Methods: We analyzed 338 patients treated with NAC followed by RC from January 1995 through December 2013. The association of ICS with 90-day surgical morbidity, incidence of major complication, 90-day readmission, and lymph node metastasis was determined. Generalized linear models were used to determine potential predictors of each endpoint. Patients were stratified into four groups by ICS days (18 – 42; 43 – 64; 64 – 85; > 85). Complications were classified using the Clavien system. Results: The overall morbidity of the cohort was 59%, with 66% being minor, and 34% being major complications. The median ICS was 46 days (18 – 199 days). There was no difference in the overall morbidity, readmission, or major complication rates among the four groups. Patients with an ICT > 85 days had the highest incidence of lymph node metastasis (40%), though this was not found to be significant (p = 0.1). On multivariate analysis including predictors of perioperative morbidity, extravesical (pT3 – 4) disease (OR = 1.97; p = 0.01) was an independent predictor of overall morbidity, while age at cystectomy (OR = 1.05; p = 0.004), and surgical time ≥ 7 hrs (OR = 2.87; p = 0.001) were independent predictors of major complications. Only surgical time ≥ 7 hrs (OR = 2.24; p = 0.006) was found to be a predictor of readmission. In a separate multivariate analysis that included risk factors for pathological node positivity, the predictors for lymph node metastasis included variant histology (OR = 2.06; p = 0.026) and extravesical disease (OR = 2.76; p = 0.002). Patients with an ICT > 85 days had a higher risk of node metastasis though this was not significant. Conclusions: Patients can undergo RC anytime between 2.5 – 12 weeks after NAC with no difference in risk of surgical complications or nodal metastasis.

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