Oncological outcomes of radical cystectomy for bladder cancer: Laparoscopy versus open surgery

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16059-e16059
Author(s):  
J. Guillotreau ◽  
X. Gamé ◽  
M. Mouzin ◽  
N. Doumerc ◽  
B. Malavaud ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Open Surgery ◽  
Randomized Study ◽  
Transitional Cell ◽  
Surgical Margin ◽  
Rank Test ◽  
Positive Surgical Margin ◽  
Oncological Outcomes

e16059 Background: To compare the oncological outcomes of laparoscopic versus open surgery in radical cystectomy for bladder cancer. Methods: A prospective non-randomized study was conducted between January 2003 and November 2008 in 52 patients, 2 women and 50 men, who underwent radical cystectomy for bladder cancer. Thirty seven cystectomies were carried out by laparoscopic surgery (LS) and 15 by open surgery (OS). Mean patient age was 67.3 ± 9.7 years. The median preoperative ASA score was 2 (1–3) in both groups. Kaplan-Meier curves were constructed to estimate the survival rate for the whole sample. Datas were compared by Log-rank test. Current followup, overall and specific deaths were used as endpoints. The survival time was defined as the time elapsed from the date of radical cystectomy to the endpoint. Results: All tumours were transitional cell carcinoma, high-grade and stage < pT3b pN0. One patient of OS group had a positive surgical margin. Eight patients (15.4%), 7 of LS group and 1 of OS group, completed 5 years of follow-up. At the last follow-up 40 patients (76.9%) were alive with no evidence of disease and 5 (9.6%) died, two patients (3.8%) from metastasis and 3 (5.7%) from different causes. No patient developed port- site metastasis. Overall survival was significantly better in LS group than in the OS group (p=0.039). No statistical difference was noted for Specific survival. Mean patient follow-up was 30.9 ± 20.3 months. Conclusions: The data suggest that LRC provides oncological outcomes comparable to contemporary series of open RC. No significant financial relationships to disclose.

scholarly journals Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Giovanni Cochetti ◽  
Francesco Barillaro ◽  
Andrea Boni ◽  
Ettore Mearini
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Intraoperative Complications ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Tertiary Institution ◽  
Cancer Specific Survival

Objective.To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy.Materials and Methods.In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months.Results.Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months.Conclusions.Immediate surgical management seems feasible, safe, and efficacious.

Incidental prostate cancer in patients with radical cystectomy for bladder cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 225-225
Author(s):  
Hooman Djaladat ◽  
Max H. Bruins ◽  
Eila C. Skinner ◽  
Gus Miranda ◽  
Jie Cai ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Transitional Cell ◽  
Prostate Adenocarcinoma ◽  
Adjuvant Radiation ◽  
Incidental Prostate Cancer ◽  
Hormone Ablation ◽  
Multifocal Disease

225 Background: Radical cystectomy is the gold standard surgical treatment for invasive bladder cancer. Prostate adenocarcinoma is often found incidentally in the cystoprostatectomy specimen. The clinical significance of this type of cancer has not been well characterized. We reviewed the cohort of male patients with bladder cancer who underwent radical cystectomy and found to have incidental prostate adenocarcinoma. Methods: 1,964 patients with primary transitional cell carcinoma of bladder underwent radical cystectomy between 1971 and 2008 with a median follow-up of 12.1 yrs (0.1-36) at USC. 1553 of them were male (79%) and 559 (36%) had incidental pathologic prostate adenocarcinoma (PC-group). Prostate and bladder cancer characteristics, recurrence and overall survival (OS) in the cohort of PC-group are reviewed. Results: Median age in the PC-group was 69 yo (35-92). The incidental PC was organ confined (OC) in 527 patients (94%). 32 (6%) had non-OC prostate cancer, treated by adjuvant radiation (5), hormone ablation (3) with a median follow-up of 3.9 yrs (0.1-16). Median pre-op PSA was 1.66 (0.01-83) in PC-group and 1.31 (0.01-33.2) in non-PC group. Gleason score was ≤ 6 in 458 (82%), 7 in 78 (14%) and ≥ 8 in 12 (2%) cases. Reviewing bladder cancer in the PC vs. non-PC group, 84 and 83% had high-grade cancer, 63 and 58% had associated CIS, 41 and 36% had multifocal disease and 29 and 27% had LVI respectively (P > 0.05). Incidental PC did not have significant effect on recurrence (P=0.3) and OS (P=0.4) after cystectomy for bladder urothelial cancer. No patient died of PC. 5-year OS rate was 60 ± 2% in both PC and non-PC groups. 10-year OS rate was also comparable at 42 ± 2% in PC and 44 ± 2% in non-PC-group. Conclusions: Incidental prostate adenocarcinoma is reported in more than one third of patients who undergo radical cystectomy for bladder cancer. It is organ confined in most of the cases and has no correlation with bladder cancer stage. Outcome of patients with incidental prostate adenocarcinoma at the time of radical cystectomy relies exclusively on the bladder cancer.

scholarly journals Early Oncological and Functional Outcomes of Prostate Capsule Sparing Cystectomy Compared with Standard Radical Cystectomy

2019 ◽  
Vol 13 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Ahmed Y. Abdelaziz ◽  
Hossam Shaker ◽  
Mohamed Seifelnasr ◽  
Hossam Elfol ◽  
Mohamed Nazim ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Randomized Study ◽  
Transitional Cell ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Oncological Outcomes ◽  
Significant Difference ◽  
Group 2 ◽  
Prostate Capsule ◽  
Group 1

Introduction and Objectives: A comparative study of standard radical cystectomy and prostate capsule sparing radical cystectomy regarding functional and oncological outcomes. Materials and Methods: A randomized study of 96 patients with transitional cell carcinoma of the bladder (December 2014 - June 2016) was done. We excluded cases with preoperative T4 staging, lymphadenopathy, prostatic specific antigen > 4 ng/dl, and cases with positive biopsies from the bladder neck, trigone, and/or prostatic urethra. Patients were divided into 2 groups, Group 1: standard radical cystectomy with orthotopic diversion (n = 51), Group 2: prostate capsule sparing cystectomy with orthotopic diversion (n = 45). Preoperative transrectal ultrasound and prostatic biopsies were done in Group 2 to exclude prostate cancer. We compared the urinary continence and erectile function in both groups after 6 months, 1, and 2 years. Results: There was no significant difference between the groups regarding preoperative demographic data, tumor stage, grade, site by cystoscopy, and biopsy. Intraoperative monitoring showed no significant differences regarding blood loss, surgical complications, or operative time (2.5 ± 0.48 vs. 2.4 ± 0.45 h). There was a significantly higher percentage of continence and potency in Group 2 than in Group 1. Sixteen cases (35.6%) in Group 2 but only 4 cases (7.8%) in Group 1 developed large post-voiding residual urine and needed intermittent self-catheterization cleaning (p = 0.001). The tumor recurrence rate was not significantly different between the groups after 2 years (p = 0.3). Conclusion: Prostate capsule sparing cystectomy is a good option in selected cases with better continence and potency and without compromising oncological outcomes after 2 years.

scholarly journals Complete TURBT Before Radical Cystectomy Did Not Improve Oncological Outcome for Organ-Confined Bladder Cancer

2020 ◽  
Author(s):  
Hai-tao Liang ◽  
Zhan-ping Xu ◽  
Zhi-jun Lin ◽  
Zi-ke Qin ◽  
Yun-lin Ye
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Tumor Size ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Surgical Margin ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Histological Variants ◽  
Disease Free

Abstract Background To investigate the role of complete transurethral resection of bladder tumor (TURBT) before radical cystectomy for organ-confined bladder cancer.Patients and Methods Patients who underwent radical cystectomy (RC) in our center from January 2008 to December 2018 were retrospectively reviewed. Those with disease >T2N0M0 or positive surgical margin and those who were administrated neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded. Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or specimen of RC. Kaplan–Meier and log-rank tests assessed disease-free survival. Logistic and Cox regression analysis were performed to identify potential predictors.Results In total, 236 patients were included, and 207 patients were male. The median age was 61 years old. The median number and size were 1 and 3cm respectively, and maximal pathological T stage was T2 in 94 patients. Complete TURBT was related to tumor size (p=0.041), histological variants (p=0.026) and downstaging (p<0.001). Tumor size, grade and histological variants were independent predictors of complete TURBT. With a median follow-up of 42.7 months, 30 patients experienced recurrence. Age and histological variantswere independent predictors of disease-free survival (p=0.022 and 0.032, respectively), and complete TURBT was not an independent predictor of disease-free survival (p=0.156). Downstaging was not associated with survival outcome.Conclusions Complete TURBT is related to an increased rate of downstaging before radical cystectomy, and it was not associated with better oncological outcomes for patients with organ-confined bladder cancer.

scholarly journals 1202 Urinary Continence and Oncological Outcomes in Robotic-Assisted Radical Prostatectomy Patients According to Nerve Spare Technique

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Ghazal-Aswad ◽  
F Kum ◽  
C Brown
Keyword(s):  
Surgical Margin ◽  
Oncological Outcome ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Positive Surgical Margin ◽  
Oncological Outcomes ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Robotic Assisted Radical Prostatectomy

Abstract Aim To assess the effects of nerve sparing (NS) on recovery of urinary continence, oncological outcome, and positive surgical margin (PSM) rates in patients undergoing robotic-assisted radical prostatectomy (RARP). Method Retrospective analysis of patients who underwent RARP between January-December 2017 at a single high- volume centre was undertaken. Urinary continence and symptoms according to different NS types (Non-NS, Unilateral, Bilateral) at 2, 6, 12, and 24 months were collated. COX proportional hazards model and Kaplan-Meier were used to correlate NS type with achievement of a dry-state; pad-free state; and oncological outcome defined by biochemical (PSA) recurrence (BCR), over 2 years follow-up. PSM occurrence was compared in non-nerve spared versus nerve spared prostate lobes. Results 241 patients underwent full analysis, Non-NS = 30 (12%), Unilateral = 84 (35%), Bilateral = 127 (53%). Comparing each NS cohort, there was no significant difference in the Mean (±SD) number of pads used per day, or rates-of-dryness at all time points during follow-up. Both COX-regression and Kaplan-Meier analyses found no significant association between any NS-type and biochemical recurrence or final achievement of continence. There was no significant risk association between NS-type and PSM rate, or significant difference in the rate of PSM between lobes that were nerve spared or not. Conclusions The degree of nerve sparing does not appear to enhance post-RARP continence recovery and is not associated with worse oncological outcomes, studied as positive surgical margin rates and biochemical recurrence at all time points up to 2 years of follow-up.

scholarly journals Relevance of prostate cancer in patients with synchronous invasive bladder urothelial carcinoma: a monocentric retrospective analysis

2015 ◽  
Vol 87 (1) ◽  
pp. 76 ◽  
Author(s):  
Lucio Dell’Atti
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Statistical Significance ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Cancer Specific Survival ◽  
Incidental Prostate Cancer ◽  
Clinically Significant

Objectives: We retrospectively reviewed data of patients with incidental prostate cancer (PCa) who underwent radical cystoprostatectomy (RCP) for invasive bladder cancer and we analyzed their features with regard to incidence, pathologic characteristics, clinical significance, and implications for management. Material and Methods: Clinical data and pathological features of 64 patients who underwent standard RCP for bladder cancer were included in this study. Besides the urothelial carcinoma of the urinary bladder, the location and tumor volume of the PCa, prostate apex involvement, Gleason score, pathological staging and surgical margins were evaluated. Clinically significant PCa was defined as a tumor with a Gleason 4 or 5 pattern, stage ≥ pT3, lymph node involvement, positive surgical margin or multifocality of three or more lesions. Postoperative follow-up was scheduled every 3 months in the first year, every 6 months in the second and third year, annually thereafter. Results: 11 out of 64 patients (17.2%) who underwent RCP had incidentally diagnosed PCa. 3 cases (27.3%) were diagnosed as significant PCa, while 8 cases (72.7%) were clinically insignificant. The positive surgical margin of PCa was detected in 1 patient with significant disease. The prostate apex involvement was present in 1 patient of the significant PCa group. Median follow-up period was 47.8 ± 29.2 (range 4-79). During the follow-up, biochemical recurrence occurred in 1 patient (9%). Concernig the cancer specific survival there was no statistical significance (P = 0.326) between the clinically significant and clinical insignificant cancer group. Conclusions: In line with published studies, incidental PCa does not impact on the prognosis of bladder cancer of patients undergoing RCP.

610 Oncological outcomes of positive surgical margin locations in pn0 m0 bladder cancer

2012 ◽  
Vol 11 (1) ◽  
pp. e610-e610b
Author(s):  
Y. Neuzillet ◽  
T. Lebret ◽  
G. Defortescu ◽  
H. Toledano ◽  
T. Murez ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Oncological Outcomes

scholarly journals Comparison of open and laparoscopic radical cystectomy as regards long-term oncological outcomes for bladder cancer

2021 ◽  
Vol 42 (2) ◽  
pp. 123-130
Author(s):  
Thanachai Sirikul ◽  
◽  
Supon Sriplakich ◽  
Akara Amantakul ◽  
◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Open Radical Cystectomy

Objective: Recently, the laparoscopic technique has become widely accepted as a minimally invasive modality which reduces morbidity and provides similar oncological outcomes to open surgery. However, the number of clinical trials comparing laparoscopic and open radical cystectomy are limited. The objectives of this study are to compare the long-term oncological outcomes between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) for bladder cancer. Materials and Methods: Out of 144 radical cystectomy patients admitted to our institute from January 2006 to December 2016, 87 patients were categorized as being in the LRC group, and 57 patients in the ORC group. Baseline characteristics, perioperative variables, and pathology results were collected retrospectively. Oncological outcomes including overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed and compared between the two groups. Results: The mean age of the patients was 64.19 ± 9.89 years in the ORC group and 61.90 ± 10.47 years in the LRC group. The most frequent urinary diversion procedure in both groups was ileal conduit. All pathology results between the LRC group and the ORC group showed no statistical significance. The median follow-up duration was 57.18 ± 44.68 months in the ORC group and 53.96 ± 34.97 months in the LRC group. There was no statistically significant difference in overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) between the groups (p = 0.322, 0.946, and 0.528, respectively). Conclusion: Our study demonstrated that the long-term oncological outcome of LRC is comparable to ORC in the management of bladder cancer. LRC is an alternative option to open radical cystectomy and is safe, effective, and feasible. However, further large comparative studies with adequate long-term follow-up are recommended to support our results.

scholarly journals Complete TURBT before Radical Cystectomy is not a Risk Factor for Organ-Confined Bladder Cancer: A Case Control Study

2021 ◽  
Author(s):  
Mingrui Luo ◽  
Zhan-ping Xu ◽  
Zhi-jun Lin ◽  
Zi-ke Qin ◽  
Yun-lin Ye
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Tumor Size ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Surgical Margin ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Histological Variants ◽  
Disease Free

Abstract Background To investigate the role of complete transurethral resection of bladder tumor (TURBT) before radical cystectomy for organ-confined bladder cancer.Patients and MethodsPatients who underwent radical cystectomy (RC) in our center from January 2008 to December 2018 were retrospectively reviewed. Those with disease >T2N0M0 or positive surgical margin and those who were administrated neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded. Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or specimen of RC. Kaplan–Meier and log-rank tests assessed disease-free survival. Logistic and Cox regression analysis were performed to identify potential predictors.ResultsIn total, 236 patients were included, and 207 patients were male. The median age was 61 years old. The median number and size were 1 and 3cm respectively, and maximal pathological T stage was T2 in 94 patients. Complete TURBT was related to tumor size (p=0.041), histological variants (p=0.026) and downstaging (p<0.001). Tumor size, grade and histological variants were independent predictors of complete TURBT. With a median follow-up of 42.7 months, 30 patients experienced recurrence. Age and histological variantswere independent predictors of disease-free survival (p=0.022 and 0.032, respectively), and complete TURBT was not an independent predictor of disease-free survival (p=0.156). Downstaging was not associated with survival outcome.Conclusions Complete TURBT is related to an increased rate of downstaging before radical cystectomy, and it was not associated with better oncological outcomes for patients with organ-confined bladder cancer.

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