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.

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 Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016

2018 ◽  
Vol 6 (9) ◽  
pp. 1647-1651 ◽  
Author(s):  
Yudiana Wayan ◽  
Pratiwi Dinar Ayu ◽  
Oka A. A. Gde ◽  
Niryana Wayan ◽  
I Putu Eka Widyadharma
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Wound Dehiscence ◽  
Oncological Outcome ◽  
Pathological Result ◽  
Muscle Invasive

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.

Laparoscopic Radical Cystectomy with Extracorporeal Ileal Conduit Urinary Diversion for Treatment of Chinese Bladder Cancer Patients

2007 ◽  
Vol 79 (3) ◽  
pp. 204-209 ◽  
Author(s):  
Zhen-Li Gao ◽  
Jie Fan ◽  
Jun-Jie Zhao ◽  
Shu-Jie Xia ◽  
Lei Shi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit

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 The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database

2019 ◽  
Vol 14 (9) ◽  
Author(s):  
Matthew Lenardis ◽  
Benjamin Harper ◽  
Raj Satkunasivam ◽  
Zachary Klaassen ◽  
Christopher Wallis
Keyword(s):  
Body Mass Index ◽  
Bladder Cancer ◽  
Quality Improvement ◽  
Radical Cystectomy ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Major Complications ◽  
American College Of Surgeons ◽  
Perioperative Complication

Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients’ body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for nonmetastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m2, 18.5–25 kg/m2, 25–30 kg/m2, and >30 kg/m2. Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m2, 7.8% of patients with BMI 18.5–25 kg/m2, 7.9% of patients with BMI 25–30 kg/m2, and 10.8% of patient with BMI >30 kg/m2. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5–25 kg/m2, patients with BMI <18.5 kg/m2 (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07–4.78) and BMI >30 kg/m2 (OR 1.59; 95% CI 1.17–2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.

Racial disparities in the morbidity of radical cystectomy in the United States.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 304-304
Author(s):  
Tudor Borza ◽  
Chen Chen Feng ◽  
Jeffrey Leow ◽  
Benjamin I. Chung ◽  
Steven L. Chang
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Racial Disparities ◽  
Radical Cystectomy ◽  
Major Complication ◽  
The United States ◽  
Study Cohort ◽  
Complication Rates ◽  
Major Complications ◽  
Hispanic Patients

304 Background: Racial disparities in the management of bladder cancer have been previously reported. However, limited data exists on inequalities in the morbidity of radical cystectomy. We performed a contemporary population-based analysis to examine the association between race and surgical complications among patients undergoing radical cystectomy. Methods: We analyzed the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US. We identified patients who underwent radical cystectomy between 2003 and 2010 based on ICD-9 code (57.71). Primary outcome measure was 90-day major complication rates, defined as Clavien Classification System Grade 3-5, derived from ICD-9 codes. Multivariable logistic regression models were developed adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates to evaluate 90-day major complication for all patients (Model 1), patients ≥65 years (Model 2), and Medicare only patients (Model 3). Results: Our study cohort included 50,175 patients. The majority of patients were Caucasion (76%), men (83.5%), with Medicare (64.2%). Major complication rates were 16% for Caucasions, 17% for African American, 24% for Hispanics, and 16% for Other. Compared to Caucasians, the odds ratio (OR) of major complications for Hispanics was 1.9 (p=0.03) and 2.6 (p<0.0001) in Models 1 and 2, and 1.7 (p=0.1) for Model 3. None of the other racial groups had significantly different odds of major complications compared with Caucasians. Conclusions: In the United States, Hispanic patients are the least likely to undergo radical cystectomy but have the highest rate of major complication following surgery. Our analysis shows that this disparity is uniquely absent among Hispanic patients with Medicare suggesting that barriers to healthcare may underlie the observed phenomenon. Therefore, the worse outcomes for Hispanic patients with bladder cancer may be secondary to challenges in accessing medical treatment at earlier stages of disease arising from language differences and non-U.S. citizenship status.

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