scholarly journals The British Association of Urological Surgeons radical cystectomy audit 2014/2015: An update on current practice, and an analysis of the effect of centre and surgeon case volume

2018 ◽  
Vol 12 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Sinan Khadhouri ◽  
Catherine Miller ◽  
Joanne Cresswell ◽  
Edward Rowe ◽  
Sarah Fowler ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Transitional Cell ◽  
High Volume ◽  
Median Number ◽  
British Association ◽  
Case Volume ◽  
Level Of Evidence ◽  
Laparoscopic Cystectomy ◽  
Open Radical Cystectomy ◽  
Muscle Invasive

Objective: The Consultant Outcomes Publication has made it mandatory to submit surgeon-level data on radical cystectomy (RC) practice in England. The current analysis describes contemporary surgical practice and compares this by surgeon and centre case volume. Materials and methods: Between 1 January 2014 and 31 December 2015, data on 3742 RCs performed by 161 surgeons over 84 centres were recorded on the British Association of Urological Surgeons audit and data platform. Centre case volumes were grouped as high (> 60), medium (30–60) and low (< 30), while surgeon case volumes were grouped as high (> 30), medium (8–30) and low (< 8). All data averages were for the combined 2-year period. Results: The median number of RCs performed was 16/surgeon and 31/centre; 45.4% of cases were performed for muscle-invasive transitional cell carcinoma (TCC). The commonest performed urinary diversion was ileal conduit (85.2%), followed by orthotopic bladder substitution (5.7%). Open radical cystectomy (ORC) was performed in 67.8%, robotically-assisted cystectomy (RARC) in 20.6% and laparoscopic cystectomy (LRC) in 9.1% of cases. RARC was more likely to be performed by high-volume surgeons and centres. The majority of patients underwent a lymph node dissection (LND), with rates varying from 79.5% to 90.3%. Reported rates of high-grade complication were generally low across all groups, suggesting under-reporting. There was a trend towards higher reported transfusion rates as centre volumes decreased. The median length of stay (LOS) was 7–9 days for minimally invasive approaches compared to open surgery, which was 11–12 days. Mortality rates were low across all groups. Conclusions: Compliance with the data registry is high. ORC remains the most common approach. High-case volume surgeons and centres more commonly offer RARC. The majority of patients undergo LND. There is a trend towards higher reported rates of transfusion as centre volume decreases. LOS is shorter in RARC and LRC in comparison to ORC, but is otherwise similar across centres and surgeons. Level of evidence: 2b

Robotic-assisted radical cystectomy with complete intracorporal diversion: Initial experience in a tertiary teaching hospital

2021 ◽  
pp. 205141582110391
Author(s):  
Yilu He ◽  
Ramesh Shanmugasundaram ◽  
Bishoy Hana ◽  
Steve P McCombie ◽  
Varun Bhoopathy ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Teaching Hospital ◽  
Median Number ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Neo Adjuvant Chemotherapy ◽  
Muscle Invasive

Objective: The aim of this study was to report the outcomes from robotic-assisted radical cystectomy (RARC) at an Australian public teaching hospital since the introduction of this technique in 2012. Methods: A retrospective analysis was conducted on perioperative and pathological outcomes from a consecutive series of 43 patients who underwent RARC for bladder cancer between 2012 and 2020 at Nepean Public Hospital. Results: Median operative time was 352 minutes for 32 (74.4%) patients undergoing construction of an ileal conduit, 499 minutes for nine (20.9%) patients undergoing construction of a neo-bladder and 239 minutes for two (4.7%) patients undergoing percutaneous urostomy. Median estimated blood loss was 500 mL, and median length of stay was 12 days. Complications within 60 days of any grade occurred in 63.4% of patients, and major complications (Clavien–Dindo ⩾Grade III) occurred in 20.9% of patients. The median number of lymph nodes removed was 17. Positive surgical margins occurred in 11.6% of patients overall, all in patients with T3 and above disease. Neo-adjuvant chemotherapy was utilised in 34.9% of patients overall and in 71.4% of patients with muscle-invasive urothelial cancer. Conclusion: The perioperative and pathological outcomes from RARC at our institution are comparable to the international literature. Level of evidence Level 4.

Oncologic outcomes of robot assisted vs open radical cystectomy: Results from a high-volume referral centre

2018 ◽  
Vol 17 (8) ◽  
pp. 225-226
Author(s):  
F. Chessa ◽  
A. Möller ◽  
R. Schiavina ◽  
M. Borghesi ◽  
O. Laurin ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Referral Centre ◽  
Robot Assisted ◽  
Open Radical Cystectomy

Setting standards for cystectomy using the British Association of Urological Surgeons Complex Operations Reports, 2016–2018

2021 ◽  
pp. 205141582110334
Author(s):  
Joseph B John ◽  
John Pascoe ◽  
Sarah Fowler ◽  
Edward Rowe ◽  
Alexandra Colquhoun ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Surgical Margin ◽  
Public Understanding ◽  
British Association ◽  
Invasive Bladder Cancer ◽  
Positive Surgical Margin ◽  
Muscle Invasive Bladder Cancer ◽  
Level Of Evidence ◽  
T Stage ◽  
Muscle Invasive

Objective: To produce comprehensive standards for cystectomy using contemporary data collected across a nation. Patients and methods: Surgical departments upload cystectomy data to the British Association of Urological Surgeons (BAUS) Complex Operations Database. Analysis of 2016–2018 data was performed for all recorded 5288 patients undergoing cystectomy in England. Logistic regression with general linear models was used to assess differences in patient selection between operative modalities. Analysis involved assessment of case selection, operative decisions and outcomes, case volume and pathological outcomes. Results: Using national Hospital Episode Statistics, the BAUS cystectomy dataset was estimated 93% complete. Median age was 70 years (interquartile range 63–75) and 75% were male. Charlson comorbidity index ⩽2 was reported in 87%. Primary treatment of muscle-invasive bladder cancer accounted for 46% of cases. Commonest preoperative disease stages were T2N0 and T1N0 (35% and 25% respectively). Robotic-assisted (RAC), laparoscopic (LC) and open cystectomy (OC) were performed in 41%, 5.5% and 54% of cases respectively. T-stage distribution differed by operative modality. Transfusion rates were 3.7% for RAC, 6.0% for LC and 18% for OC. Increasing positive surgical margin rates were observed with increasing T-stage, up to T3. The conversion-to-open rate for minimally-invasive surgery was 1.7%. Median annual centre and surgeon case volumes were highest for RAC. Median length of stay was 7, 10 and 10 days for RAC, LC and OC respectively. Postoperative histological upstaging was common (33% of cT1, 50% of cT2 cases). Lymph node positive rates were 28% for muscle-invasive bladder cancer. Conclusion: Analysis of this data provides understanding of ‘real-world’ cystectomy practice. Presentation of data specific to operative modality allows surgeons and centres to benchmark their respective practices. These findings offer to enhance patient and public understanding beyond that currently facilitated by publicly-facing information sources. They carry relevance by describing a near-complete and large volume of modern practice in a publicly funded healthcare system. Level of evidence: 2b

The relationship between ABO blood group type and tumor grade, stage, recurrence and progression in transitional cell carcinoma of the bladder: A preliminary report

2019 ◽  
Vol 13 (3) ◽  
pp. 205-209
Author(s):  
Deviprasad Tiwari ◽  
Harshit Garg ◽  
Brusabhanu Nayak ◽  
Prabhjot Singh ◽  
Amlesh Seth
Keyword(s):  
Bladder Cancer ◽  
Blood Group ◽  
Bladder Carcinoma ◽  
Statistical Significance ◽  
Transitional Cell ◽  
Abo Blood Group ◽  
Level Of Evidence ◽  
Muscle Invasive ◽  
Blood Grouping

Objectives: ABO blood grouping is a well-proven prognostic factor in many malignancies. This study aims to study the association and impact of ABO blood group on disease recurrence and progression in bladder carcinoma. Material and methods: Patients with bladder carcinoma undergoing transurethral resection of bladder tumor (TURBT) were studied prospectively for at least 1-year follow-up for recurrence and progression of the disease. Demographic profile along with blood group was noted. Results: Two hundred patients were included in the study and 194 patients were included in the final analysis. Muscle-invasive bladder cancer was present in 39 (20.1%) patients and the high-grade tumor was present in 88 (45.3%) patients. There was no statistical significance between the association of blood grouping and grade ( p=0.29) and stage of the disease ( p=0.20). During the follow-up period, there were 100 (64.5%) recurrences and 15 (9.7%) patients with non-muscle-invasive bladder carcinoma had progression. The association of blood group with recurrence ( p=0.66) and progression ( p=0.11) of disease was not statistically significant. Conclusion: There is no association between bladder cancer and ABO blood group in terms of grade and stage of the disease. The recurrence and progression of the disease did not differ significantly in different blood groups. Level of Evidence: 2b

Association of treatment facility case volume with survival in patients undergoing radiotherapy/chemoradiotherapy for muscle-invasive bladder cancer: An analysis of the National Cancer Database.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 295-295
Author(s):  
Amishi Bajaj ◽  
Alec Block ◽  
Brendan Martin ◽  
Mark Korpics ◽  
Courtney Hentz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Univariate Analysis ◽  
High Volume ◽  
Invasive Bladder Cancer ◽  
National Cancer Database ◽  
Treatment Facility ◽  
Case Volume ◽  
Muscle Invasive Bladder Cancer ◽  
Trimodality Therapy ◽  
Muscle Invasive

295 Background: Excellent outcomes with bladder-preserving trimodality therapy have been demonstrated at centers with expertise and high-volume. Some argue that these results may not be replicated at other centers with lower case volumes. We analyzed the National Cancer Database to determine if treatment at a high-volume facility is associated with improved overall survival (OS) for patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) for non-metastatic muscle-invasive bladder cancer (MIBC). Methods: Patients with cT2-4 N0-3 M0 transitional cell MIBC treated with RT or CRT were selected. The case volume variable was derived by calculating a count of patient records by each facility using the entire database of 439,188 patients. Multivariate analysis (MVA) was performed using the Cox proportional hazards model, which was used to assess the association of case volume with OS while controlling for clinicodemographic and treatment factors associated with OS on univariate analysis, including clustering of patients within their treatment facility type. Results: 872 patients treated with radiotherapy from 2008-2012 at 452 unique facilities were identified. 502 (58%) patients received RT, and 370 (42%) patients received CRT. The median case volume at each unique facility was 376 cases with an interquartile range of 235 – 579 cases. In the entire radiotherapy cohort, MVA controlling for patient case load, age, sex, education, T Stage, N Stage, cumulative radiotherapy dose, Charlson-Deyo comorbidity score, and geographic location, demonstrated that treatment at a facility with a higher case volume was associated with improved OS. For every 250 patient increase in facility case volume, the hazard of death at any given time for patients receiving radiotherapy decreased by 7% (HR = 0.93, 95% CI: 0.87 – 0.98, p = .01). Conclusions: To the authors’ knowledge, this is the first analysis demonstrating an association between treatment facility case volume and OS in the treatment of MIBC patients with RT or CRT. Consideration should be given to referring patients to high volume facilities for treatment of MIBC.

Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival

2018 ◽  
Vol 104 (6) ◽  
pp. 434-437
Author(s):  
Hakan Türk ◽  
Sıtkı Ün ◽  
Ahmet Cinkaya ◽  
Hilmi Kodaz ◽  
Murtaza Parvizi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Transitional Cell ◽  
Invasive Bladder Cancer ◽  
Lymph Node Status ◽  
Muscle Invasive Bladder Cancer ◽  
Cancer Specific Survival ◽  
Muscle Invasive

Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. Methods: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Results: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. Conclusions: The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

scholarly journals PD36-03 PERIOPERATIVE OUTCOMES OF OPEN RADICAL CYSTECTOMY IN OCTOGENARIANS: RESULTS FROM TWO HIGH-VOLUME CENTRES

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Vito Palumbo ◽  
Fabio Zattoni ◽  
Afrovita Kungulli ◽  
Sabrina La Falce ◽  
Mattia Calandriello ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Open Radical Cystectomy
Sign in / Sign up

Export Citation Format

Share Document