Sarcopenia as a predictor of perioperative outcomes following radical cystectomy in a contemporary cohort of patients with bladder cancer.

e16031 Background: Sarcopenia has gained considerable recognition as an important prognostic factor for complications, longer hospital stay, and survival following cystectomy for bladder cancer. However, inconsistent cutoff values to define sarcopenia have been utilized throughout the literature. Our aim was to evaluate sarcopenia as a predictor of outcomes following radical cystectomy with urinary diversion (RCUD) using the international consensus definition, Martin criteria, and Mayr criteria, as a standardized cutoff value would potentially reduce bias across studies. Methods: A retrospective analysis of patients treated with RCUD at our institution between 2010 and 2017 was performed. Sarcopenia was defined according to the aforementioned criteria and assessed by measuring total psoas area (TPA) on preoperative computerized tomography. The impact of sarcopenia on perioperative outcomes, cancer-specific survival (CSS), and overall survival (OS) was evaluated with univariate and multivariate regression models. Results: Of 258 patients who underwent RCUD, 195 had available computed tomography scans within 90 days of surgery. The median TPA scores among men and women were 578.0 and 459.6 mm2/mm2, respectively. The overall incidence of sarcopenia according to the international consensus definition, Martin criteria, and Mayr criteria was 36.4% (71/195), 24.1% (47/195), and 31.3% (61/195), respectively. Regardless of definition, significant differences were not observed in length of stay, high grade complications, readmissions, and discharge destination (all P > .05). Furthermore, sarcopenia was not significantly associated with CSS or OS. The median follow-up time was 4.1 years (95% CI: 3.6 - 4.4). The 5-year CSS and OS were 46.3% and 66.2%, respectively. Conclusions: Irrespective of definition, we were unable to externally validate sarcopenia as a predictor of perioperative outcomes in our contemporary cohort. Future studies will evaluate the impact of our evolving perioperative care pathway on oncological outcomes, including its ability to mitigate the effects of sarcopenia through reducing the physiological and mental demands of surgery.

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Preoperative Serum Gamma-Glutamyltransferase as a Prognostic Biomarker in Patients Undergoing Radical Cystectomy for Bladder Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.648904 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shiqiang Su ◽

Lizhe Liu ◽

Chao Sun ◽

Yanhua Nie ◽

Hong Guo ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Elevated Serum ◽

Disease Free Survival ◽

Prognostic Models ◽

Lymph Node Status ◽

Cancer Specific Survival ◽

Gamma Glutamyltransferase ◽

Preoperative Serum

BackgroundSerum gamma-glutamyltransferase (GGT) has been reported to be correlated with survival in a variety of malignancies. However, its effect on patients with bladder cancer (BC) treated by radical cystectomy has never been evaluated.Patients and MethodsWe retrospectively evaluated 263 patients who underwent radical surgery in our center. Baseline features, hematologic variables, and follow-up data were obtained. The endpoints included overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). The relationship between GGT and survival were evaluated.ResultsThe median follow-up period for all patients was 34.7 (22.9-45.9) months. At the last follow-up, 67 patients died, 51 patients died of cancer, 92 patients experienced disease recurrence. Patients with an elevated serum GGT had a higher rate of pT3-T4 tumors. Patients with a higher preoperative serum GGT had a lower rate of OS, CSS and DFS (P < 0.001 for all). Multivariate analysis identified that preoperative serum GGT was independent predictor of OS (HR: 3.027, 95% CI: 1.716-5.338; P < 0.001), CSS (HR: 2.115, 95% CI: 1.093-4.090; P = 0.026), DFS (HR: 2.584, 95% CI: 1.569-4.255; P < 0.001). Age, diabetes history, pathologic T stage, and lymph node status also were independent predictors of prognosis for BC patients.ConclusionsOur results indicated that preoperative serum GGT was an independent prognosis predictor for survival of BC patients after radical cystectomy, and can be included in the prognostic models.

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

Journal of Clinical Urology ◽

10.1177/20514158211041483 ◽

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.

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Downstaging of TURBT-Based Muscle-Invasive Bladder Cancer by Radical Cystectomy Predicts Better Survival

ISRN Urology ◽

10.5402/2011/458930 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6

Author(s):

P. R. van Dijk ◽

M. Ploeg ◽

K. K. H. Aben ◽

P. C. Weijerman ◽

H. F. M. Karthaus ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Relative Survival ◽

Population Based ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Cancer Specific Survival ◽

Tumor Downstaging ◽

Muscle Invasive ◽

The Impact

Differences between clinical (cT) and pathological tumor (pT) stage occur often after radical cystectomy (RC) for muscle-invasive bladder cancer. In order to evaluate the impact of downstaging on recurrence and survival, we selected patients from a large, contemporary, population-based series of 1,409 patients with MIBC. We included all patients who underwent RC (N=643) and excluded patients who received (neo)adjuvant therapy, those with known metastasis at time of diagnosis, and those with nonurothelial cell tumors. Disease outcomes were defined as recurrence-free survival (RFS) and relative survival (RS), as a good approximation of bladder cancer-specific survival. After applying the exclusion criteria, 375 patients were eligible for analysis. Tumor downstaging was found to be common after RC; in 99 patients (26.4%), tumor downstaging to non-muscle-invasive stages at RC occurred. Hydronephrosis at baseline and positive lymph nodes at RC occurred significantly less often in these patients. In 62 patients, no tumor was left in the cystectomy specimen. pT stage was pT1 in 20 patients and pTis in 17 patients. Patients with tumor downstaging have about a 30% higher RFS and RS compared to those without. Consequently, tumor downstaging is a favorable marker for prognosis after RC.

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Retrospective evaluation of the impact of non-oncologic chronic drug therapy on the survival in patients with bladder cancer

International Journal of Clinical Pharmacy ◽

10.1007/s11096-021-01343-x ◽

2021 ◽

Author(s):

Lisa Haimerl ◽

Dorothea Strobach ◽

Hanna Mannell ◽

Christian G. Stief ◽

Alexander Buchner ◽

...

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Drug Therapy ◽

Radical Cystectomy ◽

Angiotensin Receptor Blockers ◽

Recurrence Free Survival ◽

Cancer Specific Survival ◽

Free Survival ◽

Drug Classes ◽

The Impact

AbstractBackground Chronic drug therapy may impact recurrence and survival of patients with bladder cancer and thus be of concern regarding drug choice and treatment decisions. Currently, data are conflicting for some drug classes and missing for others. Objective To analyze the impact of common non-oncologic chronic drug intake on survival in patients with bladder cancer and radical cystectomy. Setting. Patients with bladder cancer and radical cystectomy (2004–2018) at the University Hospital Munich. Method Data from an established internal database with patients with bladder cancer and radical cystectomy were included in a retrospective study. Drug therapy at the time of radical cystectomy and survival data were assessed and follow-up performed 3 months after radical cystectomy and yearly until death or present. Impact on survival was analyzed for antihypertensive, antidiabetic, anti-gout, antithrombotic drugs and statins, using the Kaplan–Meier method, log-rank test and Cox-regression models. Main outcome measure Recurrence free survival, cancer specific survival and overall survival for users versus non-users of predefined drug classes. Results Medication and survival data were available in 972 patients. Median follow-up time was 22 months (IQR 7–61). In the univariate analysis, a significant negative impact among users on recurrence free survival (n = 93; p = 0.038), cancer specific survival (n = 116; p < 0.001) and overall survival (n = 116; p < 0.001) was found for calcium-channel blockers, whereas angiotensin-receptor-blockers negatively influenced overall survival (n = 96; p = 0.020), but not recurrence free survival (n = 73; p = 0.696) and cancer specific survival (n = 96; p = 0.406). No effect of angiotensin-receptor-blockers and calcium-channel blockers was seen in the multivariate analysis. None of the other studied drugs had an impact on survival. Conclusion There was no impact on bladder cancer recurrence and survival for any of the analyzed drugs. Considering our results and the controverse findings in the literature, there is currently no evidence to withhold indicated drugs or choose specific drug classes among the evaluated non-oncologic chronic drug therapies. Thus, prospective studies are required for further insight. Trail registration This is part of the trial DRKS00017080, registered 11.10.2019.

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Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer

BioMed Research International ◽

10.1155/2015/154392 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

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.

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Association between Perioperative Blood Transfusions and Clinical Outcomes in Patients Undergoing Bladder Cancer Surgery: A Systematic Review and Meta-Analysis Study

Journal of Blood Transfusion ◽

10.1155/2016/9876394 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 18

Author(s):

Juan P. Cata ◽

Javier Lasala ◽

Greg Pratt ◽

Lei Feng ◽

Jay B. Shah

Keyword(s):

Systematic Review ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Fixed Effects ◽

Meta Analysis ◽

Controlled Study ◽

Blood Transfusions ◽

Cancer Specific Survival ◽

Packed Red Blood Cells ◽

The Impact

Background. Perioperative blood transfusions are associated with poor survival in patients with solid tumors including bladder cancer. Objective. To investigate the impact of perioperative blood transfusions on oncological outcomes after radical cystectomy. Design. Systematic review and meta-analysis. Setting and Participants. Adult patients who underwent radical cystectomy for bladder cancer. Intervention. Packed red blood cells transfusion during or after radical cystectomy for bladder cancer. Outcome Measurements and Statistical Analysis. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). We calculated the pooled hazard ratio (HR) estimates and 95% confidence intervals by random and fixed effects models. Results and Limitation. Eight, seven, and five studies were included in the OS, CSS, and RFS analysis, respectively. Blood transfusions were associated with 27%, 29%, and 12% reduction in OS, CSS, and RFS, respectively. A sensitivity analysis supported the association. This study has several limitations; however the main problem is that it included only retrospective studies. Conclusions. Perioperative BT may be associated with reduced RFS, CSS, and OS in patients undergoing RC for BC. A randomized controlled study is needed to determine the causality between the administration of blood transfusions and bladder cancer recurrence.

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

Insight Urology ◽

10.52786/isu.a.34 ◽

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.

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The impact of patient-related nonmodifiable factors on perioperative outcomes following radical cystectomy with enhanced recovery protocol

Therapeutic Advances in Urology ◽

10.1177/1756287218811019 ◽

2018 ◽

Vol 10 (12) ◽

pp. 393-401 ◽

Cited By ~ 4

Author(s):

Daniel Zainfeld ◽

Jian Chen ◽

Jie Cai ◽

Gus Miranda ◽

Anne Schuckman ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Charlson Comorbidity Index ◽

Enhanced Recovery ◽

Perioperative Outcomes ◽

Patient Counseling ◽

Comorbidity Index ◽

Index 2 ◽

Eras Protocol ◽

The Impact

Background: Enhanced recovery after surgery (ERAS) protocols decrease the length of hospital stay (LOS) and complications following radical cystectomy (RC). However, the impact of non-modifiable patient factors to postoperative outcome is unclear. This study aimed to identify nonmodifiable patient and disease factors predictive of post-RC outcomes with ERAS protocols. Methods: We reviewed our institutional review board-approved prospectively maintained bladder cancer database. Patients with primary urothelial bladder cancer who underwent open RC with ERAS protocol between 2012 and 2016 were identified. Patient demographic and disease-relevant variables were reviewed. Factors predictive of LOS, 30- and 90-day complications and readmission were assessed using univariate and multivariable analyses. Results: A total of 289 patients with a median age of 70 years were included, of whom 80.6% were male, 33.6% had Charlson comorbidity index ⩾2. Median LOS was 4 days and 21.1% received intraoperative transfusion. The 30-day complication and readmission rates were 58.8% and 16.6%, respectively. Age >70 ( p = 0.02), Charlson comorbidity index ⩾2 ( p = 0.005), and intraoperative transfusion ( p = 0.03) were significantly associated with LOS. Intraoperative transfusion was significantly associated with 30-day complication and readmission ( p = 0.008, p = 0.005, respectively). No factor was found to be significantly associated with 90-day complication or readmission. Conclusions: With ERAS protocol, non-modifiable patient and disease factors influence outcomes after RC. Risk adjustment for these factors is important for patient counseling, quality assessment and future reimbursement.

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Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes

Urologia Internationalis ◽

10.1159/000512053 ◽

2021 ◽

pp. 1-8

Author(s):

Vivien Graffeille ◽

Grégory Verhoest ◽

Alexandre Gryn ◽

Solène-Florence Kammerer-Jacquet ◽

Quentin Alimi ◽

...

Keyword(s):

Bladder Cancer ◽

Multivariate Analysis ◽

High Risk ◽

Radical Cystectomy ◽

Endoscopic Resection ◽

Transurethral Resection ◽

Preoperative Imaging ◽

Cancer Specific Survival ◽

Oncological Outcomes ◽

The Impact

Objectives: The objective of this study was to assess the impact of complete transurethral resection of bladder tumors (TURBTs) before radical cystectomy on pathological and oncological outcomes of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC. Materials and Methods: The charts of all patients who underwent radical cystectomy for bladder cancer in 2 academic departments of urology between 1996 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the completeness of the last endoscopic resection before radical cystectomy: macroscopically complete transurethral resection (complete) or macroscopically incomplete transurethral resection (incomplete). The primary end point was the recurrence-free survival (RFS). Secondary end points included cancer-specific survival (CSS) and rates of pT0 and downstaging. Results: Out of 486 patients included for analysis, the TURBT immediately preceding radical cystectomy was considered macroscopically complete in 253 patients (52.1%) and incomplete in 233 patients (47.9%). In multivariate analysis, macroscopically complete TURBT was the strongest predictor of both pT0 disease (OR = 3.1; p = 0.02) and downstaging (OR = 7.1; p < 0.0001). After a median follow-up of 41 months, macroscopically complete TURBT was associated with better RFS (5-year RFS: 57 vs. 37%; p < 0.0001) and CSS (5-year CSS: 70.8 vs. 54.5%; p = 0.002). In multivariate analysis adjusting for multifocality, weight of endoscopic resection specimen, cT4 stage on preoperative imaging, interval between endoscopic resection and radical cystectomy, neoadjuvant chemotherapy, pT stage, and associated carcinoma in situ, macroscopically complete endoscopic resection remained the main predictor of better RFS (HR = 0.4; p = 0.0003) and the only preoperative factor associated with CSS (HR = 0.5; p = 0.01). Conclusion: A macroscopically complete TURBT immediately preceding radical cystectomy may improve pathological and oncological outcomes in patients with MIBC and high-risk MIBC.

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