MP46-12 TWENTY YEAR TEMPORAL TRENDS IN SHORT AND LONG-TERM OUTCOMES AFTER RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP46-12 TWENTY YEAR TEMPORAL TRENDS IN SHORT AND LONG-TERM OUTCOMES AFTER RADICAL CYSTECTOMY Majed Alrumayyan, Alexandre Zlotta, Neil Fleshner, Katherine Lajkosz, and Girish Kulkarni Majed AlrumayyanMajed Alrumayyan More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , and Girish KulkarniGirish Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy is a standard of care to treat muscle invasive urothelial bladder cancer. To improve outcomes, innovations in patient care, such as improved selection and preparation for surgery, Enhanced Recovery After Surgery protocols and implementation of extended Venous thromboembolism (VTE) prophylaxis have been introduced. The purpose of this study is to assess whether these changes have led to improvements in short and longer term outcomes in patients treated with Radical cystectomy for bladder cancer over the last 20 years. METHODS: This is a retrospective study of patients whom underwent Radical cystectomy from 2000 to 2020 in University Health Network Toronto, Canada.This time period was divided into 5 groups: 2000-2003, 2004-2007, 2008-2011, 2012-2015 and 2016-2020. Outcomes assessed included overall survival and metastasis free survival. The study also assessed the number of lymph nodes dissected, the rate of Venous thromboembolism (VTE), and use of neoadjuvant and adjuvant chemotherapy and their association with the outcomes. Univariable and multivariable analysis, adjusted for age, Charlson comorbidity index, and TNM stage, were compared between the temporal time groups. RESULTS: A total of 728 patients were included. There was no variance in age among all groups, with mean age of 68 years. 76% of patients were males. The Charlson comorbidity index mean was 3 in the last few years (p<0.001). Regarding the staging; PT0 after cystectomy was 14.3% and 14.7% from (2012-2020) (p<0.001). In the first few years, PT4 stage was found to be higher with 21%. As time evolved, Non muscle invasive bladder cancer increased to 45% (p<0.001). The mean number of lymph nodes dissected was 15 with no difference between the groups (p 0.39). In the most recent years, neoadjuvant chemotherapy was given more 34.3% and 46.6% (p<0.001). While Adjuvant Chemotherapy was given more to patients from (2000 to 2007) 27.5% and 25.2% (p<0.001). In the early years (2000-2003) VTE after surgery was 14.3% (p<0.001). VTE after neoadjuvant chemotharepy was 6.8% (p<0.001). Overall survival showed no difference in the 5 groups followed for 1 year with mortality mean between 19% and 27% and and also in the first 4 groups followed for 5 years after the surgery (p 0.67 and 0.29). Metastasis free survival as well showed no difference between the groups followed for 1 and 5 years with mean of 22.5% and 49% (p 0.23 and 0.27). CONCLUSIONS: We noted improved use of neoadjuvant chemothrepy, increase in non muscle invasive bladder cancer, decrease in VTE post surgery and stable survival rate across time. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e635 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Majed Alrumayyan More articles by this author Alexandre Zlotta More articles by this author Neil Fleshner More articles by this author Katherine Lajkosz More articles by this author Girish Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...