Abstract
ABSTRACTPurpose To evaluate the influence of preoperative renal function on survival outcomes in patients who underwent radical cystectomy (RC) with non-continent urinary diversion (UD).Materials and Methods A total of 132 patients with bladder cancer who underwent RC with non-continent UD due to urothelial carcinoma from January 2006 toMarch 2017 at our tertiary referral center were retrospectively evaluated. Patients were divided into 2 groups as those with estimated glomerular filtration rate (eGFR) <60mL/min/1.73 m2 and ≥60mL/min/1.73 m2 according to preoperative eGFR levels. Patients’ characteristics, preoperative clinical data, operative data, pathologic data, oncologic data and complications were compared between the groups.Results The mean age was 64.5±8.7 (range: 32 - 83) years and the median follow-up was 30.9±31.7 (range: 1-113) months. There were 46 patients in Group 1 and 86 patients in Group 2. There was no difference in cancer-specific mortality (45.6% for group 1 and 30.2% for group 2, p=0.078) and survival (56.8±8.3 months for group 1 and 70.5±5.9 months for group 2, p=0.087) between the groups. Overall mortality was higher (63% for group 1 and 40.7% for group 2, p=0.014) and overall survival (43.6±6.9 months for group 1 and 62.2±5.8 months for group 2, p=0.03) was lower in Group 1 compared to Group 2.Conclusions Overall mortality was higher and overall survival was lower in patients with preoperative eGFR <60mL/s. More patients had preoperative hydronephrosis with eGFR< 60mL/s.
Highlights
Radical cystectomy (RC) with extended pelvic lymph node dissection is the best choice of treatment in patients with non-metastatic muscle-invasive and high-risk non-muscle invasive bladder cancer [1,2,3,4]
We aimed to evaluate the influence of preoperative renal function on oncological outcomes and prognosis in patients who underwent RC and non-continent urinary diversion (UD)
Patients were divided into 2 groups as estimated glomerular filtration rate (eGFR)
Summary
Radical cystectomy (RC) with extended pelvic lymph node dissection is the best choice of treatment in patients with non-metastatic muscle-invasive and high-risk non-muscle invasive bladder cancer [1,2,3,4]. RC with UD is a 2-step, complex surgical procedure and is associated with significant risks of perioperative and long-term morbidity and mortality, including renal function deterioration and development of chronic renal disease (CKD) [5, 6]. The etiology of a renal function decrease after RC is likely multifactorial, including age-related changes, potential nephrotoxic chemotherapy, and the impact of patient comorbidities, which are frequent in such a population, and postoperative urinary tract obstruction and infection-related complications [7]. Patients with bladder cancer largely comprise middle aged and elderly people [8]. This is indicative of the presence of many morbidities that accompany bladder cancer in patients. Hamano et al found that advanced preoperative CKD stage was significantly associated with poor oncological outcomes of bladder cancer after RC [8]
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