Centralization of radical cystectomy for bladder cancer in a universal healthcare system: Early results from a Canadian academic center.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 516-516
Author(s):  
Jan Krzysztof Rudzinski ◽  
Niels Jacobsen ◽  
Sunita Ghosh ◽  
Scott A. North ◽  
Naveen S. Basappa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Blood Product ◽  
Perioperative Outcomes ◽  
Blood Product Transfusion ◽  
Transfusion Rate ◽  
Academic Teaching ◽  
R1 Resection

516 Background: Radical cystectomy for bladder cancer is a complex surgical oncology procedure. Centralization of this procedure to high volume, fellowship-trained surgeons may improve clinical outcomes. Our objective was to compare outcomes of radical cystectomy before and after centralization of care. Methods: A retrospective analysis of data from the University of Alberta Radical Cystectomy Database was performed. Eligible subjects were those with histologically proven urothelial carcinoma of the bladder (cTanyN1-3M0) undergoing curative intent surgery. Patients were classified into pre-centralization era (1994-2007; N = 523) and post-centralization era (2013-present; N = 134) cohorts for analyses. Pre-centralization era patients were treated by 1 of 11 urologic surgeons at 2 academic teaching hospitals. Post-centralization era patients were treated by 1 of 2 fellowship-trained urologic oncologists at 1 academic teaching hospital. Outcomes were overall survival, 90-day mortality rate, positive surgical margin (R1) resection rate, total number of lymph nodes evaluated, and 90-day blood product transfusion rate. The Kaplan-Meier method and multivariable regression analyses were used to analyze survival outcomes. Statistical tests were two-sided (p≤0.05). Results: The median follow-up duration in the pre- and post-centralization era was 33 months and 16 months, respectively. The predicted 2-year overall survival rate was 62% in the pre-centralization era and 84% in the post-centralization era (Log rank P = 0.0007; multivariable HR 0.40, 95% CI 0.24 to 0.68, P < 0.0001). Treatment in the post-centralization era was associated with lower 90-day mortality (6.3% versus 1.5%, multivariable OR 0.23, 95% CI 0.06 to 0.99, P = 0.049), R1 resection (13.0% versus 1.5%; multivariable OR 0.07, 95% CI 0.01 to 0.51, P = 0.009), and 90-day blood product transfusion (59% versus 6%, P < 0.0001) as well as higher total number of lymph nodes evaluated (7 versus 30 lymph nodes, P < 0.0001). Conclusions: Surgical treatment in the post-centralization era was associated with superior survival, cancer control, and perioperative outcomes.

scholarly journals Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

2019 ◽  
Vol 47 (10) ◽  
pp. 4604-4618 ◽  
Author(s):  
Hongbin Shi ◽  
Jiangsong Li ◽  
Kui Li ◽  
Xiaobo Yang ◽  
Zaisheng Zhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bladder Cancer ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Lymph Node Yield ◽  
Multicenter Rct ◽  
Open Radical Cystectomy

Background We performed a systematic review and meta-analysis to evaluate the efficacy and safety of minimally invasive radical cystectomy (MIRC) versus open radical cystectomy (ORC) for bladder cancer. Methods We searched the EMBASE and MEDLINE databases to identify randomized controlled trials (RCTs) of MIRC versus ORC in the treatment of bladder cancer. Results Eight articles describing nine RCTs (803 patients) were analyzed. No significant differences were found between MIRC and ORC in two oncologic outcomes: the recurrence rate and mortality. Additionally, no significant differences were found in three pathologic outcomes: lymph node yield, positive lymph nodes, and positive surgical margins. With respect to perioperative outcomes, however, MIRC showed a significantly longer operating time, less estimated blood loss, lower blood transfusion rate, shorter time to regular diet, and shorter length of hospital stay than ORC. The incidence of complications was similar between the two techniques. We found no statistically significant differences in the above outcomes between robot-assisted radical cystectomy and ORC or between laparoscopic radical cystectomy and ORC with the exception of the complication rate. Conclusions MIRC is an effective and safe surgical approach in the treatment of bladder cancer. However, a large-scale multicenter RCT is needed to confirm these findings.

scholarly journals Perioperative Outcomes of Different Surgical Methods Among Bladder Cancer Patients Undergoing Radical Cystectomy With Neobladder Urinary Diversion

2021 ◽  
Vol 19 (4) ◽  
pp. 261-270
Author(s):  
Hak Ju Kim ◽  
Changhee Ye ◽  
Jin Hyuck Kim ◽  
Hwanik Kim ◽  
Sangchul Lee ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Major Complication ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Major Complications ◽  
Surgical Methods ◽  
Significant Factors

Purpose: To compare perioperative outcomes according to surgical methods among bladder cancer patients who underwent radical cystectomy (RC) with neobladder urinary diversion.Materials and Methods: Between June 2007 and January 2020, 89 bladder cancer patients who received RC with neobladder urinary diversion were enrolled in this study. Patients were stratified into surgical methods – (1) open RC with neobladder (ONB) reconstruction, (2) robotassisted RC (RARC) with extracorporeal neobladder (ECNB) reconstruction, and (3) RARC with intracorporeal neobladder (ICNB) reconstruction. Perioperative outcomes were compared among the 3 groups, with major complications defined according to Clavien-Dindo grades III–V within 90 days. Logistic regression analysis was performed to identify significant factors for postoperative complications.Results: Of 89 patients, 28 (31%) had ONB, 31 (35%) had ECNB, and 30 (34%) had ICNB. The median operative time was 471 minutes, and the ICNB group (424.5 minutes) was significantly less than ONB (444.5 minutes) and ECNB groups (542.9 minutes) (p=0.001). Transfusion rate was also significantly less in the ICNB group (13%) (p=0.001). Complications were recorded in 67 patients (75%) and major complications in 22 of all patients (25%). The major complication rate was significantly less in ICNB (13.4%) than in ONB (25%) and ECNB (35%) (p=0.003). Multivariate analysis showed surgical methods (ICNB) (odds ratio [OR], 0.709; p=0.003) and age (OR, 1.150; p=0.001) were significant factors related to occurrence of major postoperative complications.Conclusions: RARC with ICNB reduces postoperative complications compared to ONB and ECNB.

Radical Cystectomy for Bladder Cancer Today—A Homogeneous Series Without Neoadjuvant Therapy

2003 ◽  
Vol 21 (4) ◽  
pp. 690-696 ◽  
Author(s):  
Stephan Madersbacher ◽  
Werner Hochreiter ◽  
Fiona Burkhard ◽  
George N. Thalmann ◽  
Hansjörg Danuser ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Pelvic Lymphadenectomy ◽  
Node Negative ◽  
Cancer Of The Bladder ◽  
Metastatic Patterns ◽  
Positive Lymph Nodes

Purpose: To investigate the effect of pelvic lymph node dissection and radical cystectomy for transitional cell cancer of the bladder on recurrence-free and overall survival, pelvic recurrences, and metastatic patterns in a homogeneous group. Patients and Methods: A consecutive series of patients undergoing pelvic lymphadenectomy and radical cystectomy between 1985 and 2000 was analyzed. All patients were staged N0, M0 preoperatively, and no patient received neoadjuvant radio/chemotherapy. Pathologic characteristics based on the 1997 tumor-node-metastasis system, recurrence-free/overall survival, and metastatic patterns were determined. Results: Five hundred seven patients (age 66 ± 12 years) with a mean follow-up time of 45 months (range, 0.1 to 176 months) were analyzed. Five-year recurrence-free and overall survival were, respectively, 73% and 62% for patients with organ-confined, lymph node-negative tumors (n = 217; ≤ pT2, pN0) and 56% and 49% for non-organ-confined, lymph node-negative tumors (n = 166; > pT2, pN0). Positive lymph nodes were found in 124 (24%) patients who had a 5-year recurrence-free (33%) or overall (26%) survival. Isolated local recurrences were observed in 3% of patients with organ-confined tumors (≤ pT2, pN0), 11% with non-organ-confined tumors (> pT2, pN0), and 13% with positive lymph nodes (any pT, pN+). Distant metastases developed in 25% of patients with organ-confined tumors, 37% with non-organ-confined tumors, and 51% with positive lymph nodes. Conclusion: Despite negative preoperative staging, pelvic lymphadenectomy and cystectomy for bladder cancer reveal a high percentage of unsuspected nodal metastases (24%) that have a 25% chance for long-term survival. This procedure also ensures a low pelvic recurrence rate even in lymph node-positive patients, and patients with locally advanced cancer have a 56% probability of 5-year recurrence-free survival.

Assessing the minimum number of lymph nodes needed at radical cystectomy in patients with bladder cancer

2009 ◽  
Vol 103 (10) ◽  
pp. 1359-1362 ◽  
Author(s):  
Umberto Capitanio ◽  
Nazareno Suardi ◽  
Shahrokh F. Shariat ◽  
Yair Lotan ◽  
Ganesh S. Palapattu ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Minimum Number

A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

2021 ◽  
pp. 205141582110414
Author(s):  
Francesco Chiancone ◽  
Francesco Persico ◽  
Marco Fabiano ◽  
Maurizio Fedelini ◽  
Clemente Meccariello ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
Multivariate Logistic Regression Model ◽  
Increased Risk

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

Disease Progression in Bladder Cancer: Which Developments since 1994

2009 ◽  
Vol 76 (2) ◽  
pp. 115-117
Author(s):  
V. Varca ◽  
A. Simonato ◽  
P. Traverso ◽  
A. Romagnoli ◽  
F. Venzano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Public Awareness ◽  
Locally Advanced ◽  
Node Dissection ◽  
Group 2

Objectives The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006. Methods 456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition. Results For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group. Conclusions Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.

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