Radical Cystectomy In Patients Research Articles

Development of a pre- and postoperative physical activity promotion program integrated in the electronic health system of patients with bladder cancer (The POPEYE study): An intervention mapping approach.

Uptake of sufficient physical activity before and after radical cystectomy is important to improve physical and psychosocial outcomes in bladder cancer (BC) patients. In this paper, we describe the development of an evidence-based and theory-informed intervention, guided by the steps of the Intervention Mapping approach, to promote physical activity before and after radical cystectomy in patients with BC. The intervention is a home-based physical activity program. The preoperative timeframe of the intervention is 4 or 12weeks, depending on administration of neoadjuvant chemotherapy. Postoperatively, the intervention will last for 12weeks. The intervention consists of a digital oncological platform (DOP), several consultations with healthcare professionals, personal booklet and follow-up phone calls. DOP includes information, diaries, visual representation of progress, mailbox, videos of peers and treating physician explaining the benefits of physical activity, photo material of exercises and a walking program with an activity tracker. Individual goals will be set and will be self-monitored by the patient through DOP. Patients will receive alerts and regular feedback. Intervention Mapping ensures transparency of all intervention components and offers a useful approach for the development of behaviour change interventions for cancer patients and for translation of theories into practice.

Modified Ileal Neobladder: Experience of 37 Cases

Bladder cancer is the second most common malignancy of genitourinary tract. About 20% cases are muscle invasive and most of the non-muscle invasive bladder cancer progressed to muscle invasion with time. The standard care for organ confined muscle invasive bladder cancer is radical cystectomy followed by urinary diversion. Orthotopic bladder substitution is considered standard urinary diversion after radical cystectomy in patients who have no urethral malignancy and intact external urethral sphincter. Neobladder constructed from ileum as described by Studer is considered standard and followed by most centers worldwide since 1985. We modified the procedure to improve the outcome and minimize post-operative complications by reducing the length of ileum used for construction of neobladder in 37 patients. Voiding, storage function and complications were evaluated during follow-up period up to 24 months after surgery. Three patients died during follow-up period of which 2 from metastatic disease and one from unrelated cause. Daytime and night-time continence rates were 86.49% and 78.38% respectively. Average functional capacity (437ml), maximum flow rate(15.7ml/s) and mean post void residual urine (44ml) during the period of evaluation. Clean intermittent self-catheterization needed in 67.57% patients due to incomplete emptying during early postoperative period but after 3 months most of the patients learnt to void without any aid. Upper tract dilatation found in one patient due to stricture at urethrovesical junction and required endoscopic incision and dilatation later. 12 patients had an urodynamic study at 12 months after surgery and found low pressure reservoir with small residual urine in all cases. Modified ileal neobladder is a safe and reliable procedure with satisfactory short-term result. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.20-24

P085 - Cutaneous ureterostomy or ileal conduit urinary diversion: Can we spare the bowel following radical cystectomy in patients with solitary functioning kidney?

P085 - Cutaneous ureterostomy or ileal conduit urinary diversion: Can we spare the bowel following radical cystectomy in patients with solitary functioning kidney?

Intensified and Standardized Digital Communication with Cystectomy Patients as a Potentially Simple and Effective Modality for Early Detection of Postoperative Complications: Results from a Pilot Study

BackgroundPostoperative readmission rates following radical cystectomy remain significant. Early identification of emerging complications could potentially allow for immediate institution of therapy. ObjectiveTo intensify postoperative patient-physician communication via a cellphone-based health care application (CHA) and to evaluate its potential for early detection of complications. Design, setting, and participantsThis was a pilot study involving 18 radical cystectomy patients. During the first 30 d, patients received a push cellphone notification twice a week requesting data input into the CHA. This was reduced to once a week from day 31 to day 90. De-identified recorded data were reviewed by the surgeon involved. If deemed necessary, patients were contacted by the surgeon via telephone to obtain more detailed clinical information. Outcome measurements and statistical analysisDescriptive statistics were used. Results and limitationsOf the 18 patients enrolled, all completed the 90-d reporting period. On two occasions, interventions were necessary on the basis of data recorded on the CHA. One neobladder patient was given antibiotic therapy for pyelonephritis. Another patient reported weight loss and nausea with clinical suspicion of metabolic acidosis, and his sodium bicarbonate and fluid intake were increased. Limitations include the small number of cases from a single low-volume center. ConclusionsCHA-based monitoring of clinical parameters within the crucial 90-d postoperative period following radical cystectomy provides meaningful information. In this pilot study, two potential readmissions were possibly avoided on the basis of recorded basic vital signs and early intervention. Patient summaryBesides regular clinic follow-up visits after radical cystectomy, additional aids such as a cellphone-based health care application can provide treating physicians with relevant clinical information and may help to identify imminent deviations from normal postoperative recovery at an early stage.

Development and validation of a prognostic nomogram for predicting cancer-specific survival after radical cystectomy in patients with bladder cancer:A population-based study.

PurposeTo establish a prognostic model to estimate the cancer‐specific survival (CSS) for urothelial carcinoma of bladder (UCB) patients after radical cystectomy (RC).MethodsA total of 8650 candidates (2004–2011) obtained from the Surveillance, Epidemiology, and End Results (SEER) database were randomly split into development cohort (n = 4323) and validation cohort (n = 4327). We performed Cox regression analysis to identify prognostic factors and Kaplan‐Meier analysis to assess survival outcome. A nomogram predicting CSS was constructed. Its performance was validated by calibration curves, the receiver operating characteristic (ROC) curves, concordance index (C‐index), decision curve analysis (DCA), the net reclassification improvement (NRI), and the integrated discrimination improvement (IDI).ResultsThe nomogram incorporated marital status, T stage, N stage, tumor size, and chemotherapy. In validation cohort, C‐index of the nomogram was 0.707. AUC of the nomogram and AJCC stage were 0.767 versus 0.674. Calibration plots for 3‐ and 5‐year CSS displayed good concordance. DCA curves of the nomogram exhibited larger benefits than the AJCC stage. The NRI and IDI indicated the nomogram outperformed AJCC stage.ConclusionsWe have established a prognostic nomogram with improved discriminative ability and clinical benefits for UCB patients after RC. The nomogram alongside an easy access web tool may assist clinicians in optimizing the postoperative management.

Prediction of the Need for an Extended Lymphadenectomy at the Time of Radical Cystectomy in Patients with Bladder Cancer

BackgroundA prospective randomized trial (LEA AUO AB 25/02) found no survival benefit in extended compared with limited pelvic lymph node dissection (PLND) templates in bladder cancer (BCa) patients treated with radical cystectomy (RC). However, the rate of lymph node invasion (LNI) in the standard and extended templates was lower than estimated. ObjectiveTo assess the accuracy of preoperative clinical and pathological parameters to predict LNI and to develop a model to preoperatively select candidates for the extended PLND templates. Design, setting, and participantsA total of 903 BCa patients treated at a single institution were retrospectively identified. The primary outcome was to identify preoperatively the risk of LNI to tailor the type of PLND. The extended PLND templates consisted in the removal of pelvic lymph nodes together with the common iliac, presacral, para-aortocaval, interaortocaval, and paracaval sites up to the inferior mesenteric artery. InterventionA total of 903 BCa patients were treated with RC and bilateral extended PLND templates. Outcome measurements and statistical analysisSeveral models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analyses. A nomogram predicting LNI in the extended pattern was developed and validated internally. Results and limitationsOverall, 55 patients (6.1%) had LNI in the extended PLND templates at RC. The median number of nodes removed was 19 (interquartile range: 13–26). A model including age, clinical T stage, clinical node stage, lymphovascular invasion, and presence of carcinoma in situ at the last transurethral resection before RC was developed. The AUC of this model is 73%. Using a cutoff of 3%, 108 extended PLNDs (12%) would be spared and only two LNIs (3%) would be missed. The main limitations of our model are the retrospective nature of the data, lack of external validation, and low rate of LNI. ConclusionsThis is the first proposed model to predict LNI in the extended PLND templates. This model might help urologists identify which patients might benefit from an extended PLND at the time of RC, reserving a standard PLND for all the others. Patient summaryWe developed the first nomogram to predict lymph node invasion (LNI) in the extended pelvic lymph node dissection templates in bladder cancer patients treated with radical cystectomy. The adoption of our model to identify candidates for the extended pelvic lymph node dissection templates could avoid up to 12% of these procedures at the cost of missing only 3% of patients with LNI.

Efficacy of neoadjuvant atezolizumab treatment in patients with advanced urothelial bladder cancer according to the BASQ classification: a study protocol for an open-label, two-cohort, phase II trial

IntroductionAtezolizumab is a programmed death ligand-1 inhibitor for urothelial bladder cancer treatment. Atezolizumab has become the standard therapy for patients with urothelial bladder cancer who are not responding to cisplatin-based...

Variant histology in bladder cancer: diagnostic and clinical implications.

Urothelial carcinoma differentiates into variant histological subtypes in approximately 25% of cases. Since every histological variant has unique characteristics, including metastatic potential, expression of immunotherapy targets, and susceptibility to radiation or chemotherapy, every variant offers a unique diagnostic and therapeutic challenge. However, since any single variant is relatively rare, there is a risk of missed pathological diagnosis and sub-optimal clinical management. Ensuring awareness among pathologists and wide-spread familiarity with the nuances of variants among urologists is therefore essential. Additionally, variant histologies may act as an intermediate between classical clinicopathological staging of bladder cancer and evolving molecular classification. Therefore, this review aims to provide a brief overview of the diagnostic, prognostic, and therapeutic implications of each variant histologic subtype. Despite the development of standardized diagnostic criteria, the diagnosis of variant histologies continues to pose a challenge and results in significant interobserver variability. The prognosis of any single variant is poorly studied. However, squamous and glandular differentiation are thought to have little effect on prognosis while micropapillary, sarcomatoid, plasmacytoid, and small cell carcinomas are associated with a poor prognosis. Although evidence surrounding therapeutic strategies is sparse, management guidelines have been developed for variant histologies, which are often treated more aggressively than pure urothelial carcinoma. For example, the presence of variant histology warrants radical cystectomy in patients with T1 disease. Recommendations surrounding neo-adjuvant chemotherapy and radiation therapy also differ with each variant. As new treatments emerge for advanced bladder cancer, studying outcomes in each variant will become critical. Since prognosis and management hinge on the presence of variant histologies, accurate diagnosis and a thorough understanding of these variants are imperative for optimal management of urothelial carcinoma.

A Qualitative Assessment of Patient Satisfaction with Radical Cystectomy for Bladder Cancer at a Single Institution: How Can We Improve?

PurposeTo evaluate patient satisfaction (with emphasis on preoperative education) with radical cystectomy for bladder cancer at our institution, the University of Missouri Hospital, qualitatively in order to identify specific areas where improvements can be made.Materials and MethodsWe developed a patient survey that used open-ended questions to identify positive and negative experiences that contributed to patient satisfaction. We administered the survey to radical cystectomy patients who met inclusion criteria and agreed to participate. We recorded, transcribed and qualitatively coded the responses. We identified four themes under which both positive and negative responses were placed, and constructed two diagrams to better illustrate contributors to patient experience and satisfaction.ResultsWe identified 25 patients who met inclusion criteria. Of those, 13 participated in the survey. Regarding overall experience, 92.3% of patients rated their care as excellent or good. Regarding preoperative education, 76.9% of patients reported they definitely or somewhat received enough information on what to expect after surgery, and 76.9% definitely received enough guidance on how to care for themselves after surgery. From qualitative coding of patient responses to open-ended questions, we identified preoperative preparation, delivery of care, caregiver availability, and patient-centered care as themes that contributed positively and negatively to patient experience.ConclusionAlthough the overall patient satisfaction could be perceived as high (92.3%), qualitative analysis revealed several areas where improvements can be made to improve patient experience with radical cystectomy at our institution. As previously expected, preoperative preparation was a contributor.

The Relationship of Perioperative Blood Transfusion With Bladder Cancer Mortality In Radical Cystectomy Patients

Background: Perioperative blood transfusion is correlated to adverse effects which lead to mortality on a few cases of patients with malignancy, especially kidney tumors. The objective of this study is to evaluate the relationship between blood transfusion timings and survival of patients with bladder cancer who undergo radical cystectomy and measure the differences in the outcomes between patients undergoing intraoperative blood transfusion and patients undergoing blood transfusion after surgery.Methods: This research is a retrospective analytic study with a cohort design. Thirty patients with bladder tumors who performed radical cystectomy and did not undergo perioperativechemotherapy were included in the study data. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed by the Kaplan-Meier method and compared between groups with log-rank tests. Chi-square test was used for comparative evaluation of each group. Univariate and multivariate analyzes were performed to evaluate the relationship between clinical and pathological variables with risks such as RFS, CSS, and OS. P<.005 were considered statistically significant, and SPSS software was used for the entire analysis process.Results: From a total of 29 patients who had a radical cystectomy, 22 patients received perioperative blood transfusion. The 17 patients had the transfusion intraoperatively while the rest had the transfusion after the operation. The mean of blood loss was 1491 cc and the mean of survival was 13.2 months. Intraoperative blood transfusion was associated with a significantly increased risk of disease recurrence (HR: 1.32; P=.034), bladder cancer mortality (HR: 1.65; P=.015), and all-cause mortality (HR: 12.38; P=.013).Conclusions: Intraoperative blood transfusion is significantly associated with an increased risk of cancer mortality. Further investigation is needed to determine the biological mechanismsunderlying patient outcomes.

Plasma Fibrinogen Predicts the Prognosis of Bladder Cancer Patients After Radical Cystectomy.

BackgroundThis study aimed to determine the potential utility of plasma fibrinogen as a prognostic factor in patients with bladder cancer (BCa) after radical cystectomy (RC).MethodsPatients with BCa who underwent RC from 2014 to 2019 were analyzed retrospectively. The indexes of plasma coagulation and fibrinolysis system factors were collected. Kaplan–Meier survival curves were used to calculate the overall survival (OS) and disease-free survival (DFS). The prognostic value of plasma fibrinogen was analyzed by using Cox regression model, and a nomogram of BCa based on plasma fibrinogen was generated by R software.ResultsAmong 145 patients, the optimal cut-off value of plasma fibrinogen was 3.14g/L. High level of plasma fibrinogen was related to the poor prognosis of patients with BCa, and plasma fibrinogen has a more accurate prognostic ability than other plasma coagulation and fibrinolysis system factors. Multivariate Cox regression analysis showed that plasma fibrinogen was an independent predictor of OS (>3.14 vs ≤3.14 HR, 2.58, 95% CI = 1.28–5.23; p = 0.008) and DFS (>3.14 vs ≤3.14 HR, 2.60, 95% CI = 1.20–5.65; p = 0.016), and the nomogram based on plasma fibrinogen had better accuracy and discrimination (area under the curve (AUC): OS = 0.741, DFS = 0.733).ConclusionPlasma fibrinogen can be used as an independent predictor of OS and DFS for RC patients, and the nomogram based on plasma fibrinogen was a reliable model for predicting the prognosis after RC.

AUTHOR REPLY

We were able to decrease inpatient postoperative opioid use and pain scores in radical cystectomy patients through dedicated adherence to ERAS protocols by our providers, nursing staff and patients. Certainly, there are limitations in the interpretation of our results as this was a retrospective, observational study. Despite this, we believe ERAS pathways promote several fundamental concepts that optimize perioperative urologic care.

Re: Surgical Safety of Radical Cystectomy and Pelvic Lymph Node Dissection following Neoadjuvant Pembrolizumab in Patients with Bladder Cancer: Prospective Assessment of Perioperative Outcomes from the PURE-01 Trial.

No AccessJournal of UrologyUrological Survey1 Nov 2020Re: Surgical Safety of Radical Cystectomy and Pelvic Lymph Node Dissection following Neoadjuvant Pembrolizumab in Patients with Bladder Cancer: Prospective Assessment of Perioperative Outcomes from the PURE-01 Trial Sam S. ChangMD Sam S. ChangSam S. Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001260AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Surgical Safety of Radical Cystectomy and Pelvic Lymph Node Dissection following Neoadjuvant Pembrolizumab in Patients with Bladder Cancer: Prospective Assessment of Perioperative Outcomes from the PURE-01 Trial." The Journal of Urology, 204(5), pp. 1094–1095 Reference 1. : Pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive urothelial bladder carcinoma (PURE-01): an open-label, single-arm, phase II study. J Clin Oncol 2018; 36: 3353. Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 5November 2020Page: 1094-1095 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sam S. Chang More articles by this author Expand All Advertisement PDF DownloadLoading ...

Oncological outcome according to attainment of pentafecta after robot-assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database.

To investigate the oncological significance of a robot-assisted radical cystectomy (RARC)-related pentafecta in patients with bladder cancer. Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien-Dindo grade 3-5) within 90days; (iv) no clinical recurrence within the first 12months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox proportional analysis was then carried out. Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1months of follow-up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non-attainment group (10-year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10-year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.

Impact of hospital and surgeon volumes on short-term and long-term outcomes of radical cystectomy.

There is heightened awareness and trends towards centralizing high-risk, complex surgeries such as radical cystectomy to minimize complications and improve survival. However, after nearly a decade of mandated and/or passive centralization of care, debate regarding its benefits and harms continues. During the past decade, mandated and passive centralization has led to an increase in radical cystectomies performed in high-volume hospitals (HVHs) and, perhaps by high-volume surgeons (HVS), in addition to efforts to increase the uptake of multidisciplinary strategies in the management of radical cystectomy patients. Consequently, 30 and 90-day mortality rates and overall survival have improved, and major complications and transfusion rates have decreased. Factors impacting surgical quality, such as negative surgical margin(s), pelvic lymphadenectomy and/or lymph node yield rates have increased. However, current studies have not demonstrated a coadditive impact of centralization on oncological outcomes (i.e. cancer-specific and recurrence-free survival). The benefits of centralization on oncologic survival of radical cystectomy remain unclear given the varied definitions of HVHs and HVSs across studies. In fact, centralization of radical cystectomy could lead to an increase in patient load in HVHs and for HVSs, thereby leading to longer surgery waiting times, a factor that is important in the management of muscle-invasive bladder cancer. The benefits of centralization of radical cystectomy with multidisciplinary management are shown increasingly and convincingly. More studies are necessary to prospectively test the benefits, risks and harms of centralization.

Androgen receptor and immune cell PD-L1 expression in bladder tumors predicts disease recurrence and survival.

The impact of sex hormones on cancer immunotherapy remains controversial. Androgens, via the androgen receptor (AR), may impact the success of immune checkpoint blockade. This study characterizes AR and programmed death ligand-1 (PD-L1) expression in bladder tumors with long clinical follow-up. AR and PD-L1 expression was analyzed using immunohistochemistry on 143 transurethral resection (TUR) and 203 radical cystectomy (RC) specimens. Descriptive statistics and survival analyses assessed the relationship of AR and PD-L1 staining with clinical outcomes of tumor recurrence, progression, and overall survival. AR expression was observed in a higher proportion of TUR than RC specimens (59% vs 35%, p < 0.001). High immune cell (IC) PD-L1 expression was associated with higher stage and grade. Patients with the combination of an absence of AR expression and the highest (> 10%) IC PD-L1 expression in TUR tumors had an increased risk of recurrence and progression. In RC specimens, the expression of AR increased the risk of local recurrence (adjusted hazard ratio (HR) 2.09, 95% CI 0.98-4.45), which was even higher among patients who also had IC PD-L1 expression (HR 4.16, 95% CI 1.28-13.52). For 28 paired metastatic lymph nodes among RC patients, tumor cell PD-L1 expression was significantly correlated (r = 0.48, p = 0.01), while no relationship with IC PD-L1 expression was observed. The expression of AR and its relationship to clinical outcomes appears to vary between non-muscle invasive and muscle-invasive bladder cancer. Our results support the role of IC PD-L1 expression as an independent risk factor for bladder cancer outcomes.

Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

Prognostic impact of preoperative renal function in patients treated with radical cystectomy: a multi-institutional retrospective study.

Little data on the preoperative prognostic factors in radical cystectomy (RC) patients have made it difficult to choose the appropriate type of urothelial diversion (UD). This study aimed to investigate the prognostic role of UD, with a subgroup analysis of that of preoperative renal function. From 1990 to 2015, 279 patients underwent RC for bladder cancer at six hospitals affiliated with Kitasato University in Japan. All patients were divided into three groups: cutaneous ureterostomy (CU; n = 54), ileal conduit (IC; n = 139), and orthotopic neobladder (NB; n = 86). Patients were also stratified into three groups based on preoperative estimated glomerular filtration rate (eGFR) (mL/min/1.73m2): normal eGFR (> 60mL/min/1.73m2; n = 149), moderately reduced eGFR (45-60mL/min/1.73m2; n = 66), and severely reduced eGFR (< 45mL/min/1.73m2; n = 37). Statistical analyses were performed to investigate prognostic values of UD and preoperative eGFR. Kaplan-Meier analyses showed that progression-free survival (PFS) and cancer-specific survival (CSS) did not differ between the three types of UD groups. With regard to renal function, the preoperative severely reduced group had significantly worse PFS and CSS than the other groups. The multivariate analysis showed that severely reduced preoperative eGFR was an independent risk factor of worse PFS and worse CSS. The present study demonstrated that preoperative severe renal function was shown as an independent risk factor of both PFS and CSS.

Rethinking the one-size-fits-most approach to venous thromboembolism prophylaxis after radical cystectomy

Empirically dosed enoxaparin is routinely given in the postoperative period for venous thromboembolism (VTE) prophylaxis after radical cystectomy (RC). Patient-specific factors may alter its pharmacokinetics, and it is unclear whether this leads to levels sufficient for antithrombosis. We sought to evaluate variability of anti-factor Xa levels in a cohort of RC patients receiving perioperative enoxaparin prophylaxis. Patients undergoing RC at a single institution were placed on a postoperative pathway that included enoxaparin. An anti-factor Xa level was drawn 2 to 4 hours after the third dose. The target range for prophylaxis was 0.3 IU/ml to 0.5 IU/ml. The primary outcome was anti-factor Xa level. Demographics, operative time, hospital course, and 30-days post-operative VTE were compared by anti-factor Xa level group using univariate and multivariable analyses. Between January 2018 and 2019, 107 RC patients remained on pathway and were included in our analysis. Sixty-five (61%) were below target range for VTE prophylaxis. A single VTE event (0.9%) occurred in a subprophylacticindividual. The subprophylactic group had a significantly higher body mass index (P < 0.01) than those within target range. Higher body mass index was associated with subprophylactic enoxaparin dosing after RC. Nearly two-thirds of patients had below target anti-factor Xa levels. This suggests that dosing could be further individualized, but given the low incidence of VTE, implications of dose-adjusted prophylaxis on VTE prevention remainunknown.

PT401 - Preoperative frailty promotes sarcopenia after radical cystectomy in patients with muscle-invasive bladder cancer

PT401 - Preoperative frailty promotes sarcopenia after radical cystectomy in patients with muscle-invasive bladder cancer