Patients Undergoing Radical Cystectomy Research Articles

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

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.

Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases.

There are conflicting reports on outcome trends following radical cystectomy (RC) for bladder cancer. Evolution of modern bladder cancer management and its impact on outcomes was analyzed using a longitudinal cohort of 3,347 patients who underwent RC at an academic center between 1971 and 2018. Outcomes included recurrence-free survival (RFS) and overall survival (OS). Associations were assessed using univariable and multivariable models. In all, 70.9% of cases underwent open RC in the last decade, although trend for robot-assisted RC rose since 2009. While lymphadenectomy template remained consistent, nodal submission changed to anatomical packets in 2002 with increase in yield (p <0.001). Neoadjuvant chemotherapy (NAC) use increased with time with concomitant decrease in adjuvant chemotherapy; this was notable in the last decade (p <0.001) and coincided with improved pT0N0M0 rate (p=0.013). Median 5-year RFS and OS probabilities were 65% and 55%, respectively. Advanced stage, NAC, delay to RC, lymphovascular invasion and positive margins were associated with worse RFS (all, multivariable p <0.001). RFS remained stable over time (p=0.73) but OS improved (5-year probability, 1990-1999 51%, 2010-2018 62%; p=0.019). Among patients with extravesical and/or node-positive disease, those who received NAC had worse outcomes than those who directly underwent RC (p ≤0.001). Despite perioperative and surgical advances, and improved pT0N0M0 rates, there has been no overall change in RFS trend following RC, although OS rates have improved. While patients who are downstaged with NAC derive great benefit, our real-world experience highlights the importance of preemptively identifying NAC nonresponders who may have worse post-RC outcomes.

The prognostic value of the preoperative lung immune prognostic index in patients with urothelial bladder cancer undergoing radical cystectomy.

The lung immune prognostic index (LIPI) predicts the prognosis of patients with advanced non-small-cell lung cancer and is a prognostic biomarker for renal cell carcinoma and melanoma; however, no study has evaluated its potential as a preoperative biomarker for patients with bladder cancer (BC). We investigated the LIPI as a preoperative prognostic biomarker in patients undergoing radical cystectomy. We retrospectively analyzed the clinical records of 105 patients with BC who underwent radical cystectomy from January 2013 to June 2019. The LIPI was evaluated based on the preoperatively derived neutrophil-lymphocyte ratio and the lactate dehydrogenase levels. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and decision curve analysis (DCA) were performed to assess the disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates. The patients were classified into the good, intermediate, and poor LIPI groups [71 (67.6%), 28 (26.7%), and 6 (5.7%) patients, respectively]. IPTW-adjusted Kaplan-Meier curve analyses showed that patients with intermediate to poor LIPI had worse DFS, CSS, and OS rates than those with good LIPI. The LIPI combined with pT3/4 and lymph node metastasis could better assess the prognosis of DFS at 24months postoperatively by DCA. The preoperative LIPI can predict the prognosis of patients with BC undergoing radical cystectomy and has a better predictive ability when combined with pT3/4 and lymph node metastasis.

Prognostic Value of Lymphocyte–C-Reactive Protein Ratio in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Population-Based Study

PurposeThis study aimed to assess the prognostic value of the lymphocyte–C-reactive protein ratio (LCR) in patients with bladder cancer (BCa) who underwent radical cystectomy (RC).Materials and MethodsBCa patients between 2009 and 2018 were retrieved from our medical center. The predictive value of LCR on survival of BCa patients was evaluated through the Kaplan–Meier survival and receiver operating characteristic (ROC) curves. The multivariate Cox regression results were used for conducting the nomogram, which were further verified by ROC, decision curve analysis (DCA), and calibration curves. Propensity score matching (PSM) was performed to validate our findings.ResultsA total of 201 BCa patients who received RC were included in this study, with 62 (30.8%) patients in the low LCR group and 139 (69.2%) in the high LCR group. Multivariate analysis results revealed that the high LCR group was significantly related to better prognosis and functioned as a prognostic biomarker for overall survival (OS) [hazard ratio (HR) = 0.41, 95% CI, 0.26–0.66; p < 0.001] and disease-free survival (DFS) [HR = 0.40, 95% CI, 0.26–0.66; p < 0.001]. The nomogram processed better predictive capability and accuracy than TNM stage from ROC results (AUC = 0.754 vs. AUC = 0.715), with the confirmation of calibration curves and DCA. The result of PSM confirmed that LCR was significantly correlated with OS and DFS.ConclusionOur finding demonstrates that LCR is a novel, convenient, and effective predictor that may provide vital assistance for clinical decision and individualized therapy in BCa patients after RC.

Prospective versus retrospective recordings of comorbidities and complications in bladder cancer patients undergoing radical cystectomy – a randomized controlled trial

Background Patients undergoing radical cystectomy are predominantly elderly with many comorbidities and high risk of complications. Studies on comorbidity and complications following cancer surgery are often based on data collected retrospectively from records. However, prospective registration is often considered a more valid source of information. Therefore, it is relevant to investigate if the amount and severity of complications and comorbidities is valid when using retrospective registration compared to a more meticulous prospective registration. Objective To investigate the difference in registered comorbidities and complications between prospective and retrospective data collection in patients with bladder cancer undergoing radical cystectomy. Method Seventy-three bladder cancer patients undergoing radical cystectomy were randomized to receive prospective or retrospective collection of data regarding comorbidities and complications. Data in the prospective arm was collected daily during hospitalization, 14-days after discharge and 90-days postoperatively. In the retrospective arm, medical records were reviewed retrospectively at 90-days. Comorbidities were compared using the Charlson Comorbidity Index (CCI) and complications were reported as overall, minor and major dependent on Clavien Dindo Classification (CDC). The primary endpoint was the difference in overall complication rate. Results No statistically significant difference in CCI was observed with median [IQR] 2[0;3] and 1[0;2] (p = 0.21). No statistically significant difference was found regarding all, minor (CDC I-II) or major (CDC III-V) complications at all three time points. Conclusion No statistically significant difference in comorbidity and complications between retrospectively and prospectively collected data was observed. We find that retrospective collected data is reliable when strict reporting guidelines are used in this single-centre study.

Health-related Quality of Life for Patients Undergoing Radical Cystectomy: Results of a Large Prospective Cohort

BackgroundRadical cystectomy (RC) has the potential for profound changes to health-related quality of life (HRQOL). ObjectiveTo evaluate a broad range of HRQOL outcomes in a large RC cohort. Design, setting, and participantsA single-center prospective study enrolled RC patients from 2008 to 2014. We collected 14 separate patient-reported outcome measures at the presurgical visit and at 3, 6, 12, 18, and 24 mo after RC. Outcome measurements and statistical analysisTo visualize the patterns of recovery over time across domains, we used generalized estimating equations (GEEs) with nonlinear terms. Given substantial differences in patient selection for the type of urinary diversion, we separately modeled longitudinal HRQOL within conduit and continent diversion groups. The mean pre-RC scores were compared to illustrate the baseline HRQOL differences between diversion groups. Results and limitationsThe analyzed cohort included 411 patients (n = 205 ileal conduit, n = 206 continent diversion). At baseline, patients receiving continent diversion reported better mean physical (p < 0.001), urinary (p = 0.006), and sexual function (p < 0.001), but lower social function (p = 0.015). After RC, GEE modeling showed physical function scores decreasing 5/100 points by 6 mo, and subsequently stabilizing or returning to baseline. By 12 mo, social function improved by 10/100 points among continent diversions, while remaining stable among ileal conduits. Global quality of life exceeded baseline scores by 6 mo. Sexual function scores were low before RC, with limited recovery. Psychosocial domains were stable or improved, except for 10/100-point worsening of body image among ileal conduits. ConclusionsRC patients reported favorable HRQOL recovery within 24 mo in most areas other than body image (ileal conduits) and sexual function (both). Importantly, large measurable decreases in scores were not reported by 3 mo after RC. These contemporary outcomes and the excellent locoregional control provided by RC further support it as the gold standard therapy for high-risk bladder cancer. Patient summaryWe review quality of life in the 24 mo following radical cystectomy. Large decreases in health-related quality of life were not reported, with most areas returning to, or exceeding, baseline, except for sexual function and body image.

An emerging role for immuno-nutrition in patients undergoing radical cystectomy

An emerging role for immuno-nutrition in patients undergoing radical cystectomy

Single-Port Robotic Radical Cystectomy with Intracorporeal Bowel Diversion: Initial Experience and Review of Surgical Outcomes.

Introduction and Objective: Scant literature is available on surgical outcomes of radical cystectomies on the new single-port (SP) system. This study compares short-term outcomes in patients undergoing radical cystectomy with those undergoing intracorporeal urinary diversion (ICUD) on the multiport (MP) vs SP platform. Methods: This institutional review board approved study used a prospective cystectomy database and nonparametric testing including chi-squared, Mann-Whitney U, and Fisher exact tests to analyze all variables stratified by surgical approach. Results: Thirty-four patients underwent radical cystectomy with ICUD from September 1, 2019, to February 8, 2021. Twenty patients were in the MP cohort, whereas 14 were in the SP group. Table 1 presents the demographics of both groups and shows no statistically significant differences. Intra- and postoperative as well as pathology data are given in Table 2. Patients in the SP group had less narcotic use (MP: 25 morphine milligram equivalent [MME] vs SP: 11.5 MME, p = 0.047) and shorter return of bowel function (MP: 3 days vs SP: 2 days, p = 0.032). Operative times were similar between both groups despite having fewer patients undergoing ileal conduit (MP: 85% vs SP: 50%, p = 0.027) in the SP group. In Table 3, we list the early short-term postoperative follow-up data for each group that showed no significant differences between the two groups with an average follow-up of 4.9 months for MP and 4.4 months for SP. Conclusions: Our initial experience with SP robotic cystectomy and ICUD appears to be safe and an effective alternative to MP cystectomies. A learning curve was involved but the overall transition from MP to SP was smooth. Operative times were similar despite fewer patients undergoing ileal diversion, shorter return of bowel function, and less narcotic use in the SP group. Further studies including longer follow-ups with multi-institutional data are underway.

Perioperative Ernährungsinterventionen im Rahmen einer radikalen Zystektomie bei Harnblasenkarzinom

Perioperative Ernährungsinterventionen im Rahmen einer radikalen Zystektomie bei Harnblasenkarzinom

SC291 - Is higher BMI an influencing factor for surgical recovery in patients undergoing radical cystectomy and enhanced recovery after surgery program?

SC291 - Is higher BMI an influencing factor for surgical recovery in patients undergoing radical cystectomy and enhanced recovery after surgery program?

SC289 - ERAS versus standard protocol for patients undergoing radical cystectomy and urinary diversion for bladder cancer: our experience

SC289 - ERAS versus standard protocol for patients undergoing radical cystectomy and urinary diversion for bladder cancer: our experience

SC296 - Temporal trend analyses of stage, surgical technique, oncological treatment, and post-operative outcomes in a large cohort of patients undergoing radical cystectomy at a referral institution

SC296 - Temporal trend analyses of stage, surgical technique, oncological treatment, and post-operative outcomes in a large cohort of patients undergoing radical cystectomy at a referral institution

Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate.

We aimed to establish the reliability of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder. A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were compared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system. Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leakage rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03). Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower incidence of postoperative complications in Wallace group.

Enhanced Recovery after Surgery for Radical Cystectomy Decreases Postoperative Complications at Different Times

Introduction: This study aimed to assess whether enhanced recovery after surgery (ERAS) improves, at different time points, postoperative complications in patients undergoing radical cystectomy. Methods: We performed a retrospective monocentric study using prospectively maintained databases including all patients treated by radical cystectomy between January 2015 and July 2019. An ERAS protocol was applied in all patients from February 2018. We analyzed and compared between non-ERAS and ERAS groups early and 90-day postoperative complications and 90-day readmission. ERAS was analyzed to know its implication in fast recovery improvement over time. Results: A total of 150 patients underwent radical cystectomy, 74 without ERAS and 76 with ERAS protocol. ERAS decreased significantly early (p = 0.039) and 90-day (0.012) postoperative complications. In multivariate analysis, ERAS was an independent factor associated with less early (OR: 0.48, 95% CI: 0.25–0.96; p = 0.37) and 90-day (OR: 0.31, 95% CI: 0.14–0.68; p = 0.004) postoperative complications. There was no significant difference between groups for 90-day readmission (p = 0.349). Mean length of stay did not differ significantly between ERAS and non-ERAS groups (12.7 ± 6.2 and 13.1 ± 5.7 days, respectively; p = 0.743). Discussion/Conclusion: Our study shows that ERAS has an early positive impact that lasts over time on postoperative complications. ERAS implementation has decreased early and 90-day postoperative complications without increasing 90-day readmission. In our cohort, length of stay was not improved with ERAS protocol.

MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY Ziv Savin, Aviv Kupershmidt, Snir Dekalo, Dorel Poulin, Ofer Yossepowitch, Alon Lazarovich, Barak Rosenzwieg, Reut Shashar, Azik Hoffman, Jonathan Gal, Miki Haifler, and Roy Mano Ziv SavinZiv Savin More articles by this author , Aviv KupershmidtAviv Kupershmidt More articles by this author , Snir DekaloSnir Dekalo More articles by this author , Dorel PoulinDorel Poulin More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , Alon LazarovichAlon Lazarovich More articles by this author , Barak RosenzwiegBarak Rosenzwieg More articles by this author , Reut ShasharReut Shashar More articles by this author , Azik HoffmanAzik Hoffman More articles by this author , Jonathan GalJonathan Gal More articles by this author , Miki HaiflerMiki Haifler More articles by this author , and Roy ManoRoy Mano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Malnutrition Universal Screening Tool (MUST) integrates body mass index and unplanned weight loss to assess the nutritional status of patients, and was previously associated with adverse outcomes after gastrointestinal operations. The predictive role of MUST among patients undergoing radical cystectomy is unknown. METHODS: We conducted a multi-center retrospective analysis of 227 patients who underwent radical cystectomy for bladder cancer in 4 medical centers between 2015-2019. Patients were stratified according to the MUST score [MUST=0 (n=188) vs. MUST ≥1 (n=39)]. Baseline clinical, pathological and functional characteristics were compared between groups. Endpoints were 30-day postoperative morbidity, cancer-specific-survival (CSS) and overall survival (OS). Kaplan-Meier curves and cox regression analyses were used to evaluate survival and identify predictors of outcome. RESULTS: Median age of the study cohort was 69 years (IQR 63-74). Median duration of follow up was 23 months (IQR 14-35). Thirty-day major postoperative complication rate (Clavien-Dindo grade 3-5) was 17%. Estimated 2-year OS and CSS rates were 73% and 75%, respectively. Baseline characteristics were not different between the MUST groups. OS and CSS were significantly lower (p <0.001) in the malnourished group (MUST ≥1) with medians of 32 months (95%CI 20-44) and 33 months (95%CI 27-46), respectively, compared to the MUST=0 group (medians were not reached, Figure 1). There was no difference in post-operative complication rates between the groups. On multivariable analysis, MUST ≥1 was found to be an independent risk factor for overall-mortality (HR=2.4, 95%CI 1.4-4.2) and cancer-specific-death (HR=2.5, 95% CI 1.4-4.4). CONCLUSIONS: High MUST scores are associated with decreased survival in patients after radical cystectomy. Therefore, the MUST score may assist in perioperative evaluation and patient selection. Future studies should focus on whether improving the nutritional status of malnourished patients will result in improved ontological outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e762-e762 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziv Savin More articles by this author Aviv Kupershmidt More articles by this author Snir Dekalo More articles by this author Dorel Poulin More articles by this author Ofer Yossepowitch More articles by this author Alon Lazarovich More articles by this author Barak Rosenzwieg More articles by this author Reut Shashar More articles by this author Azik Hoffman More articles by this author Jonathan Gal More articles by this author Miki Haifler More articles by this author Roy Mano More articles by this author Expand All Advertisement Loading ...

PD59-05 SINGLE-PORT ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL BOWEL DIVERSION: INITIAL EXPERIENCE AND REVIEW OF EARLY SURGICAL OUTCOMES

You have accessJournal of UrologyBladder Cancer: Invasive V (PD59)1 Sep 2021PD59-05 SINGLE-PORT ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL BOWEL DIVERSION: INITIAL EXPERIENCE AND REVIEW OF EARLY SURGICAL OUTCOMES David Ali, Rohan Sawhney, Mubashir Billah, Robert Harrison, Michael Stifelman, Gregory Lovallo, Nikhil Gopal, Jay Zaifman, Salma Ahsanuddin, Tenzin Lama-Tamang, Helaine Koster, and Mutahar Ahmed David AliDavid Ali More articles by this author , Rohan SawhneyRohan Sawhney More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Robert HarrisonRobert Harrison More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , Nikhil GopalNikhil Gopal More articles by this author , Jay ZaifmanJay Zaifman More articles by this author , Salma AhsanuddinSalma Ahsanuddin More articles by this author , Tenzin Lama-TamangTenzin Lama-Tamang More articles by this author , Helaine KosterHelaine Koster More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002096.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Scant literature is available on surgical outcomes of radical cystectomies on the new single-port (SP) system. This study compares short term outcomes in patients undergoing radical cystectomy with intracorporeal urinary diversion (ICUD) on the multi-port (MP) vs. SP platform. METHODS: This IRB approved study used a prospective cystectomy database and non-parametric testing including Chi-Squared, Mann-Whitney U, and Fisher Exact tests to analyze all variables stratified by surgical approach. RESULTS: 34 patients underwent radical cystectomy with ICUD from 9/1/2019 to 2/8/2021. 20 patients were in the MP cohort, while 14 were in the SP group. Table 1 presents the demographics of both groups and shows no significant differences. Intra- and post-operative as well as pathology data is shown in Table 2. Patients in the SP group had less narcotic use (MP: 25 MME vs. SP: 11.5 MME, p=0.047) and shorter return of bowel function (MP: 3 days vs. SP: 2 days, p=0.032). Operative times were similar between both groups despite having fewer patients undergoing ileal conduit (MP: 85% vs. SP: 50%, p=0.027) in the SP group. In table 3, the early short term post-operative follow up data for each group showed no significant differences between the two groups with an average follow up of 4.9 months for MP and 4.4 months for SP. CONCLUSIONS: Our initial experience with SP robotic cystectomy and ICUD appears to be safe and an effective alternative to MP cystectomies. A learning curve was involved but the overall transition from MP to SP was smooth. Operative times were similar despite fewer patients undergoing ileal diversion, shorter return of bowel function, and less narcotic use in the SP group. Further studies including longer follow ups with multi-institutional data are underway. Source of Funding: None. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1053-e1055 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ali More articles by this author Rohan Sawhney More articles by this author Mubashir Billah More articles by this author Robert Harrison More articles by this author Michael Stifelman More articles by this author Gregory Lovallo More articles by this author Nikhil Gopal More articles by this author Jay Zaifman More articles by this author Salma Ahsanuddin More articles by this author Tenzin Lama-Tamang More articles by this author Helaine Koster More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...

PD16-01 OBJECTIVE RISK SCORE RELIABLY PREDICTS MORTALITY AFTER RADICAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD16)1 Sep 2021PD16-01 OBJECTIVE RISK SCORE RELIABLY PREDICTS MORTALITY AFTER RADICAL NEPHRECTOMY Kristen Marley, Bradley Houston, Christopher Ledbetter, Robert Wake, A. Lynn Patterson, and Maurizio Buscarini Kristen MarleyKristen Marley More articles by this author , Bradley HoustonBradley Houston More articles by this author , Christopher LedbetterChristopher Ledbetter More articles by this author , Robert WakeRobert Wake More articles by this author , A. Lynn PattersonA. Lynn Patterson More articles by this author , and Maurizio BuscariniMaurizio Buscarini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001998.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephrectomy (RN), with or without resection of the ureter, is the treatment of choice for patients with advanced malignancy of the kidney and/or upper urinary tract. We have previously developed and validated a mortality risk score to stratify postoperative outcomes in patients undergoing radical cystectomy. We hypothesized that this 30-day mortality risk score could be applied to patients undergoing RN for malignancy. METHODS: The National Surgical Quality Improvement Program (NSQIP) identified 16,617 patients that underwent RN for upper urinary tract or renal malignancy from 2013-2017. Patients with complete data were included in the analysis. Risk factors for 30-day mortality were identified on multivariable analysis using backward stepwise binary logistic regression. A previously developed and validated mortality risk score (Figure 1A) was calculated for each RN patient. A receiver operating characteristic (ROC) curve quantified the discriminatory ability of the risk calculator. Statistical significance was defined as p values <0.05. RESULTS: Of 9,345 patients included, laparoscopic/robotic technique was applied in 6,112 (65%) patients. The mean age was 64±12 years and most patients were male (n=5950, 64%). Postoperative 30-day mortality was 1.2% (n=116). Older age, elevated creatinine, lower albumin and hematocrit, congestive heart failure, exertional dyspnea, >10% weight loss, disseminated cancer, and open surgery as mortality risk factors. After RN, 30-day mortality increased nearly exponentially with escalating risk category (Figure 1B), p<0.00001. The ROC curve for the risk score is shown in Figure 1C; the area under the curve (AUC) was 0.794 (95% CI, 0.755-0.832; p<0.00001). Relative risk of 30-day mortality increased with escalating risk category: moderate risk=4.8 (2.5-9.1, p<0.00001), high risk=16.8 (9.0-31.5, p<0.00001), and extremely high risk=36.8 (13.4-101.2, p<0.00001). The risk score applied to minimally invasive (AUC, 0.785; 95% CI, 0.722-0.849; p<0.00001) and open RN (0.781; 0.730-0.832; p<0.00001). CONCLUSIONS: A previously established mortality risk score can be employed preoperatively in patients undergoing RN for malignancy to stratify 30-day mortality risk. This 30-day mortality risk score is reliable, accurate, and applicable to both minimally invasive and open RN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e278-e278 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristen Marley More articles by this author Bradley Houston More articles by this author Christopher Ledbetter More articles by this author Robert Wake More articles by this author A. Lynn Patterson More articles by this author Maurizio Buscarini More articles by this author Expand All Advertisement Loading ...

MP53-12 CUTANEOUS URETEROSTOMY: WHAT ONCE WAS OLD IS NEW AGAIN

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-12 CUTANEOUS URETEROSTOMY: WHAT ONCE WAS OLD IS NEW AGAIN Randy Casals, Tyler Overholt, Adil Siddique, Alexander Tsivian, and Matvey Tsivian Randy CasalsRandy Casals More articles by this author , Tyler OverholtTyler Overholt More articles by this author , Adil SiddiqueAdil Siddique More articles by this author , Alexander TsivianAlexander Tsivian More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cutaneous ureterostomy (CU) as an option for urinary diversion after radical cystectomy has fallen out of favor due to a perceived higher risk of stomal stenosis and eventual failure. Herein we review the literature to assess the reported outcomes of CU as a method of urinary diversion. METHODS: We reviewed the literature on the surgical outcomes of cutaneous ureterostomy on PubMed with hand searching of references. Studies were included if they presented the outcomes or techniques for CU by title, abstract, and content of the study including case series, prospective trials, and retrospective analyses. Exclusion criteria included existing literature reviews, case reports, editorials, and reports in languages other than English. The primary outcome was the tube-free rate. The secondary outcome was the rate of surgical complications. RESULTS: A total of 13 studies were reviewed (published between 1970-2019). The most common techniques of CU included the Toyoda and Ariyoshi methods, each being used in 3 different studies. Within the 11 studies that allowed for analysis of the tube-free rate, the median was 73% (range 20-95%) with a median follow-up period of 27.6 months. The rate of any stomal complications ranged from 3.8-47% and the range of gastrointestinal complications ranged from 0-3.8%. CONCLUSIONS: CU is a useful technique for urinary diversion after radical cystectomy. Although it is less popular due to a perception that it has a high failure rate, this review supports that CU is a valid choice for urinary diversion as it has a high success rate depending on the technique used and is associated with fewer perioperative gastrointestinal complications. There are several techniques to perform CU which offer surgeons many options for a diverse patient population. Considering the multiple comorbidities of many patients undergoing radical cystectomy, CU offers an option that is considerably less morbid and should be considered as an option for urinary diversion after radical cystectomy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e943-e943 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Randy Casals More articles by this author Tyler Overholt More articles by this author Adil Siddique More articles by this author Alexander Tsivian More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement Loading ...

MP13-12 PROLONGED OPERATIVE TIME COULD BE A USEFUL METRIC TO PREDICT POSTOPERATIVE COMPLICATION AND READMISSION RATES

You have accessJournal of UrologyBladder Cancer: Invasive I (MP13)1 Sep 2021MP13-12 PROLONGED OPERATIVE TIME COULD BE A USEFUL METRIC TO PREDICT POSTOPERATIVE COMPLICATION AND READMISSION RATES Peter Hanna, Joseph Zabell, Badrinath Konety, and Christopher Warlick Peter HannaPeter Hanna More articles by this author , Joseph ZabellJoseph Zabell More articles by this author , Badrinath KonetyBadrinath Konety More articles by this author , and Christopher WarlickChristopher Warlick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001994.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy is a complex lengthy procedure associated with postoperative morbidities. Operative duration has been evaluated as a potentially modifiable risk factor for postoperative complications. We assess the operative time in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates. METHODS: Retrospective cohort study including 296 patients undergoing radical cystectomy and urinary diversion from 2010 to 2018 in our institution. Operative time 369 minutes was set as a cutoff value between short and long operative time groups. Primary outcome was 90-day postoperative complication rates. Secondary outcomes were gastrointestinal recovery time, length of hospital stay (LOS), and 90-day readmission rates. RESULTS: The overall incidence of 90-day postoperative complications was 80.4% where 63.2% representing minor complications, and 36.8% representing major complications. GIT and infectious complications are the most common complications in our data set (45.9%, 45.6%, respectively). On multivariable analysis, prolonged operative time was significantly associated with odds of high-grade complications (OR 2.340, 95% CI 1.288-4.250, p=0.005) even with adjusted other variables (table 1). A higher incidence of major complications was identified in the long operative time group 69 (42.6%) compared to 40 (30.5 %) in the short operative time group (p=0.034). Though, a shorter GIT recovery time was noticed in the short operative time group (p=0.026), no differences in LOS between both groups. Prolonged operative time was associated with a higher 90-day readmission rate on univariate and multivariate analysis (p=0.001, p<0.0001, respectively). CONCLUSIONS: Prolonged operative time (> 369 min.) is associated with an increased risk of postoperative complications and readmission rates. Optimization of operative time could translate into better operative outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e248-e248 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Hanna More articles by this author Joseph Zabell More articles by this author Badrinath Konety More articles by this author Christopher Warlick More articles by this author Expand All Advertisement Loading ...

MP41-05 CHRONIC KIDNEY DISEASE AND RADICAL CYSTECTOMY FOR BLADDER CANCER: PERIOPERATIVE AND ONCOLOGIC OUTCOMES IN 1,214 PATIENTS

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-05 CHRONIC KIDNEY DISEASE AND RADICAL CYSTECTOMY FOR BLADDER CANCER: PERIOPERATIVE AND ONCOLOGIC OUTCOMES IN 1,214 PATIENTS Charles Nguyen, Saum Ghodoussipour, Matthew Winter, Giovanni Cacciamani, Hamed Ahmadi, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand, Monish Aron, Inderbir Gill, and Mihir Desai Charles NguyenCharles Nguyen More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Matthew WinterMatthew Winter More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the impact of chronic kidney disease (CKD) on outcomes after radical cystectomy (RC) and pelvic lymph node dissection in patients with bladder cancer treated within a high-volume tertiary referral center. METHODS: A total of 1,214 patients underwent RC with intent to cure from 2009 to 2019 as identified from our prospectively collated institutional database. The Modification of Diet in Renal Disease (MDRD) GFR (mL/min/1.73 m2) was calculated and the entire cohort was categorized by baseline GFR: Group A = GFR >60 (Normal), Group B = GFR >30-59 (Stage 3 CKD) and Group C = GFR <30 (Stage 4 CKD). Pre-, intra- and postoperative characteristics, oncological outcomes, and 90-day perioperative outcomes were compared. Multivariable logistic regression was used to control for confounding variables. RESULTS: We identified 722 (59.5%) patients in Group A, 448 (36.9%) in Group B and 44 (3.6%) in Group C. Patients with worse CKD were older and had significantly worse overall comorbidity (all p <0.001). On univariate analysis, worse CKD was associated with higher pathologic stage, lymph node metastases and positive soft tissue margins (all p <0.0001). The rates of blood transfusion, 90-day complications and readmissions were higher in patients with worse CKD (p <0.0001, p=0.02, p=0.04, respectively). Patients with worse CKD had worse overall survival (77% vs 73% vs 55%, p <0.0001). On multivariable analysis, worse CKD was independently associated with adverse pathology (≥pT3 or node positive) (OR=6.96, 95%CI 3.20-15.12), 90-day readmissions (OR 2.09, 95%CI 1.11-3.94) and perioperative transfusion (OR 2.08, 95%CI 1.05-4.11). CONCLUSIONS: CKD is prevalent in patients undergoing radical cystectomy. We found CKD to be independently associated with a higher likelihood of adverse pathology, 90-day readmissions, and transfusion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e761-e761 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Nguyen More articles by this author Saum Ghodoussipour More articles by this author Matthew Winter More articles by this author Giovanni Cacciamani More articles by this author Hamed Ahmadi More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement Loading ...