Radical Cystectomy In Patients Research Articles

Comparison of open and laparoscopic radical cystectomy as regards long-term oncological outcomes for bladder cancer

Objective: Recently, the laparoscopic technique has become widely accepted as a minimally invasive modality which reduces morbidity and provides similar oncological outcomes to open surgery. However, the number of clinical trials comparing laparoscopic and open radical cystectomy are limited. The objectives of this study are to compare the long-term oncological outcomes between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) for bladder cancer. Materials and Methods: Out of 144 radical cystectomy patients admitted to our institute from January 2006 to December 2016, 87 patients were categorized as being in the LRC group, and 57 patients in the ORC group. Baseline characteristics, perioperative variables, and pathology results were collected retrospectively. Oncological outcomes including overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed and compared between the two groups. Results: The mean age of the patients was 64.19 ± 9.89 years in the ORC group and 61.90 ± 10.47 years in the LRC group. The most frequent urinary diversion procedure in both groups was ileal conduit. All pathology results between the LRC group and the ORC group showed no statistical significance. The median follow-up duration was 57.18 ± 44.68 months in the ORC group and 53.96 ± 34.97 months in the LRC group. There was no statistically significant difference in overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) between the groups (p = 0.322, 0.946, and 0.528, respectively). Conclusion: Our study demonstrated that the long-term oncological outcome of LRC is comparable to ORC in the management of bladder cancer. LRC is an alternative option to open radical cystectomy and is safe, effective, and feasible. However, further large comparative studies with adequate long-term follow-up are recommended to support our results.

Risk Factors Leading to Radical Cystectomy in Patients Who Had Undergone Nephroureterectomy

Purpose: To identify the risk factors leading to radical cystectomy in patients who had undergone nephroureterectomy (NUx).Materials and Methods: We retrospectively reviewed the medical records of patients with upper tract urothelial carcinoma who underwent NUx during 2011–2019 and excluded patients with metastatic cancer. In total 646 patients were included in this study; of these, 532 had no previous bladder cancer history. Follow-up was performed every 3 months for 2 years after NUx was administered, and recurrence was confirmed using cystoscopy, urine cytology, computed tomography, and chest radiography. Bladder recurrence was confirmed through biopsy, urine cytology, or radiologic examination. Univariate and multivariate Cox regression analyzes were performed for statistical analysis of risk factors leading to radical cystectomy in patients undergoing NUx.Results: Lymphovascular invasion (LVI) (hazard ratio [HR], 4.728; 95% confidence interval [CI], 1.463–15.570; p=0.011), previous transurethral resection of bladder tumor history (HR, 3.825; 95% CI, 1.164–12.571; p=0.027), and intravesical recurrence (IVR) within 6 months (HR, 3.733; 95% CI, 1.091–12.778; p=0.036) in patients undergoing NUx are predictors of radical cystectomy implementation. In a multivariate analysis of patients without bladder cancer history, bladder recurrence was identified as a predictor of radical cystectomy implementation, if it occurred within 6 months of NUx (HR, 8.608; 95% CI, 1.545–47.976; p=0.014).Conclusions: LVI and IVR within 6 months and previous bladder cancer history are factors that can predict the need for radical cystectomy after NUx. Even in patients without bladder cancer history, early bladder recurrence within 6 months is a major predictor of radical cystectomy.

Usefulness of Preoperative High Systemic Immune-Inflammation Index as a Prognostic Biomarker in Patients Who Undergo Radical Cystectomy for Bladder Cancer: Multicenter Analysis.

Evidence of the prognostic value of pretreatment systemic immune-inflammation index (SII) after radical cystectomy (RC) for bladder cancer is limited. This study aims to assess the association between preoperative SII and prognosis after RC for bladder cancer. In this multicenter retrospective study, we calculated preoperative SII as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in 237 patients who underwent RC for bladder cancer between March 2009 and March 2018. Patients were classified into high SII and low SII groups by using the optimal cutoff value (438 × 109/L) based on receiver operating characteristic curve analysis for cancer-specific death. We compared cancer-specific survival (CSS) and overall survival (OS) between the two groups. To evaluate the prognostic impact of preoperative SII, we also performed Cox proportional regression analyses for CSS and OS. Of 237 patients, 127 patients were classified into the high SII group and 110 patients into the low SII group. During the follow-up period, 70 patients died of bladder cancer (30%) and 21 patients died from other causes (9%). Patients with high SII had significantly lower rates of CSS and OS than those with low SII (p < 0.01 and p < 0.01, respectively). Multivariable Cox proportional hazard analysis showed that high SII was independently associated with poor CSS (p = 0.01) and poor OS (p < 0.01). In conclusion, high SII could be an independent significant predictor of poor prognosis after RC in patients with bladder cancer.

Long-Term Renal Function Following Radical Cystectomy for Bladder Cancer

ObjectiveTo evaluate long-term renal function following radical cystectomy (RC) for bladder cancer and identify risk factors associated with postoperative decline in renal function. MethodsThe study included patients who underwent RC at a single centre in Denmark between 2009 and 2019. Data was collected through national electronic medical records. Renal function was evaluated by estimated glomerular filtration rate (eGFR) using pre- and postoperative creatinine measurements. Cumulative incidence and Cox Proportional Hazards models were used to describe the loss of renal function and its association with clinicopathological variables, as well as its effect on mortality. ResultsAfter exclusions, 670 patients were eligible for analyses. Median follow-up time was 6.2 years (interquartile range 4.0 –8.4). The proportion of patients with renal insufficiency (eGFR<45 mL/min) increased from 8.9% before RC to 19% 5 years after surgery. A total of 610 patients with preoperative eGFR≥45 were included in survival analyses. The absolute risk of renal function decline to CKD stage G3b or worse (eGFR<45 mL/min) was 17% (95% CI 14 –20) at 5 years postoperatively. Loss of renal function was not significantly associated with higher all-cause mortality. In multivariate analysis lower preoperative eGFR, diabetes mellitus, prior pelvic radiation therapy, continent urinary diversion types, and postoperative ureteral stricture were all independently associated with renal function decline. ConclusionThe long-term renal function decreases considerably for a large number of RC patients. Recognizing preoperative risk factors could identify patients who benefit from enhanced renal surveillance or early intervention for modifiable factors to minimize renal insufficiency following RC.

Clinical outcome and quality of life in octogenarian patients with muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy or transurethral resection of the bladder tumor: a retrospective analysis of 143 patients

PurposeTo compare clinical outcome and quality of life (QoL) in octogenarian patients with muscle-invasive urothelial carcinoma (MIBC) either treated by radical cystectomy (RC) or transurethral resection of the tumor (TURBT).MethodsWe identified octogenarian patients with MIBC in our institutions since 2005. Clinical treatment outcomes and QoL were analyzed. Uni- and multivariable Cox regression analyses, two-tailed Wilcoxon test, Mann–Whitney test and Fisher’s exact test were assessed as appropriate. QoL was evaluated using FACT-G (Functional Assessment of Cancer Therapy-General) questionnaire.Results143 patients were identified (RC: 51 cases, TURBT: 92 cases). Mean follow-up was 14 months (0–100 months). Median overall survival (OS) was 12 months in the RC group and 7 months in the TURBT group. TURBT and low preoperative hemoglobin were independent risk factors for reduced cancer-specific survival (CSS) (TURBT: p = 0.019, Hb: p = 0.008) and OS (TURBT: p = 0.026, Hb: p = 0.013) in multivariable analyses. Baseline QoL was low throughout the whole cohort. There was no difference in baseline FACT-G scoring comparing RC and TURBT (FACT-G total score (median): RC 43.7/108 vs. TURBT 44.0/108, p = 0.7144). Increased FACT-G questionnaire scoring was assessed for RC patients (median percentage score change RC 22.9%, TURBT 2.3%, p < 0.0001).ConclusionRC and TURBT are feasible treatment options for MIBC in octogenarian patients. In our cohort, RC was associated with increased CSS, OS and QoL. QoL in general was low throughout the whole cohort. Interdisciplinary decision-making has to be improved for these critically ill patients.

Clinical outcome of laparoscopic versus robot-assisted radical cystectomy for patients with bladder cancer: a retrospective study

BackgroundWith the development of minimally invasive surgery technology, patients with bladder cancer are increasingly receiving laparoscopic radical cystectomy (LRC) or robotic-assisted radical cystectomy (RARC) treatment. The main purpose of this study was to compare the long-term outcomes of bladder cancer patients treated with LRC versus RARC.MethodsA retrospective study to identify patients with clinical stage Ta/T1/Tis to T3 bladder cancer who underwent RARC or LRC has been performed. The perioperative outcome, recurrence, and overall survival (OS) of the two surgical methods were compared.Results218 patients were identified from March 2010 to December 2019 in our department, which including 82 (38%) patients who received LRC and 136 (62%) patients who received RARC. There was no significant difference between the two groups in terms of lymph node collection, lymph node positive rate, resection margin positive rate, and postoperative pathological staging. Compared with the LRC group, patients in the RARC group had a median estimated blood loss (180 vs. 250 ml; P = 0.02) and reduced complications at 90 days postoperatively (30.8% vs. 46.3%; P = 0.01). Recurrence, all-cause death, and cancer-specific death occurred in 77 (35%), 55 (25%), and 39 (18%) patients, respectively. The 5-year OS rate was 54.63% and 54.65% in the RARC and LRC group (P > 0.05). The 5-year cancer-specific survival (CSS) rate was 73.32% and 61.55% in RARC and LRC group (P > 0.05). There was no significant difference in OS [hazard ratio (HR) 1.083, 95% confidence interval (CI) 0.626–1.874; P = 0.78], and CSS (HR 0.789, 95%CI 0.411–1.515; P = 0.61) between two groups.ConclusionsBoth RARC and LRC were safe and effective with a similar long-term clinical outcomes. Moreover, RARC had significantly lower median estimated blood loss and reduced postoperative complications.

P121 - Selecting the best candidates for cisplatin-based adjuvant chemotherapy after radical cystectomy in patients with pN+ bladder cancer

P121 - Selecting the best candidates for cisplatin-based adjuvant chemotherapy after radical cystectomy in patients with pN+ bladder cancer

The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer.

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) remains the mainstay of treatment for muscle-invasive bladder cancer (MIBC). The extent of PLND and number of removed lymph nodes (LNs) have been associated with improved staging and survival outcomes in several series of RC patients. Neoadjuvant chemotherapy (NAC) has become standard of care for cisplatin-eligible patients qualified to RC, yet few studies on PLND stratified cases according to the receipt of NAC. We aimed to address this issue and reevaluate the prognostic value of PLND nodal yields in series of patients who underwent RC on the verge of the NAC era. This single-center, retrospective, clinical follow-up study enrolled 439 consecutive patients, out of whom 83 received NAC. We analyzed survival outcome of RC according to the number of removed nodes between NAC and non-NAC subgroups. We found PLND thresholds of 10 and 15 LNs prognostically meaningful in our study cohort, and this association was particularly pronounced in the non-NAC subgroup. Higher numbers of LNs provided a 25% reduction in risk of all-cause mortality and correspondingly correlated with up to a 14% increase in 3-year overall survival. The receipt of NAC diminished the benefit of adequate PLND, as the number of retrieved LNs was not associated with survival in the NAC-RC cohort. Given the limitations of our study, additional research is needed to verify these findings.

Development and Validation of a Risk-Adapted Scoring Model for Metachronous Upper Tract Urothelial Carcinoma following Radical Cystectomy

The incidence and risk factors for metachronous upper tract urothelial carcinoma (UTUC) following radical cystectomy (RC) remain incompletely defined, which has limited the ability to individualize postoperative surveillance. A retrospective review of 2 institutional registries was performed to identify patients undergoing RC for urothelial carcinoma. Multivariable Cox proportional hazard models for metachronous post-RC UTUC were developed in one institutional data set and validated in the second institutional data set. A post-RC UTUC risk score was then developed from these models. A total of 3,170 RC patients were included from the training cohort and 959 RC patients from the validation cohort. At a median followup after RC of 4.6 years (IQR 2.1-8.7), 167 patients were diagnosed with UTUC. On multivariable analysis in the training cohort, risk factors for metachronous UTUC were the presence of positive urothelial margin (HR 2.60, p <0.01), history of bacillus Calmette-Guérin treatment prior to RC (HR 2.20, p <0.01), carcinoma in situ at RC (HR 2.01, p <0.01) and pre-RC hydronephrosis (HR 1.48, p=0.04). These factors had similar discriminative capacity in the training and validation cohorts (C-statistic 0.71 and 0.73, respectively). A UTUC risk score was developed with these variables which stratified patients into low (0 points), intermediate (1-3 points), and high risk (4+ points) for post-RC UTUC, with respective 5-year UTUC-free survivals of 99%, 96%, 89% in the training cohort and 98%, 96%, and 91% in the validation cohort. We developed and validated a risk score for post-RC UTUC that may optimize UTUC surveillance protocols after RC.

MP23-02 UNDERSTANDING SHORT AND LONG-TERM OPIOID AND BENZODIAZEPINE PERI-OPERATIVE CONVERSION RATES IN PRESCRIPTION-NAÏVE RADICAL CYSTECTOMY PATIENTS

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (MP23)1 Sep 2021MP23-02 UNDERSTANDING SHORT AND LONG-TERM OPIOID AND BENZODIAZEPINE PERI-OPERATIVE CONVERSION RATES IN PRESCRIPTION-NAÏVE RADICAL CYSTECTOMY PATIENTS W. Blair Townsend, Emily Baldrige, Myra Robinson, Emily Roebuck, William M. Worrilow, Megan McDonald, Jared Brown, Caroline Lu, Samuel Ivan, Stephen B. Riggs, and PRIMUM Group W. Blair TownsendW. Blair Townsend More articles by this author , Emily BaldrigeEmily Baldrige More articles by this author , Myra RobinsonMyra Robinson More articles by this author , Emily RoebuckEmily Roebuck More articles by this author , William M. WorrilowWilliam M. Worrilow More articles by this author , Megan McDonaldMegan McDonald More articles by this author , Jared BrownJared Brown More articles by this author , Caroline LuCaroline Lu More articles by this author , Samuel IvanSamuel Ivan More articles by this author , Stephen B. RiggsStephen B. Riggs More articles by this author , and PRIMUM Group More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002014.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Limited data exist on the association of preoperative opioid and benzodiazepine (benzo) use on continued postoperative utilization in radical cystectomy (RC) patients. We sought to summarize our clinical experience with perioperative opioid and benzo use in RC patients and examine the impact of RC on long-term opioid or benzo use in prescription-naïve RC patients. METHODS: This retrospective study reviewed pre- and post-RC opioid and benzo use data from a clinical decision support intervention tool that identifies risk factors for misuse, abuse, and diversion. Primary outcomes included conversion rates of pre-operative opioid and benzo-naïve RC patients (no prescription within 1 year prior to RC) to long-term use post discharge ( >1 prescription within 3-12 mo. of discharge). Additionally, measures of opioid and benzo use [measured by any prescription, average # orders/month, and average MME/month (for opioids)] were summarized and compared between pre-RC period and short term (≤3 mo. post discharge) and long term (>3 mo. to 12 mo. post-discharge) post-RC periods. McNemar tests for agreement and Wilcoxon signed rank tests were utilized. RESULTS: From 01/2017 - 01/2020, 178 patients underwent RC at our high-volume institution. Of 85 (48%) “opioid naïve” patients, 11 (13%) converted to long-term post-RC opioid use. Of 160 (90%) “benzo naïve” patients, 2 (1%) converted to long-term post-RC benzo use. The rate of opioid use was significantly higher in the short-term post-RC period compared to pre-RC (83% v. 52%, p <0.01). Conversely, the rate of opioid use was significantly lower in the long-term post-RC period compared to pre-RC (25% v. 52%, p <0.01, Table 1). For benzos, both short term (5%) and long term (2%) post-RC benzo use were significantly lower than pre-RC benzo use (10%, p=0.03 and p <0.01, respectively). CONCLUSIONS: Overall, our study found 13% of opioid naïve subjects converted to long term post-RC opioid use, and 1% of benzo naïve patients converted to long-term post-RC benzo use. Future work is needed to understand conversion rates in a larger cohort of RC patients and to identify solutions to minimize unnecessary opioid and benzo use in surgical patients. Source of Funding: Supported in part by a cooperative agreement (CE14-004 Award # CE002520) from the CDC © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e400-e401 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information W. Blair Townsend More articles by this author Emily Baldrige More articles by this author Myra Robinson More articles by this author Emily Roebuck More articles by this author William M. Worrilow More articles by this author Megan McDonald More articles by this author Jared Brown More articles by this author Caroline Lu More articles by this author Samuel Ivan More articles by this author Stephen B. Riggs More articles by this author PRIMUM Group More articles by this author Expand All Advertisement Loading ...

MP16-18 SURVIVAL OUTCOMES AFTER RADICAL CYSTECTOMY VERSUS CONSERVATIVE MANAGEMENT FOR T1 HIGH GRADE NON-MUSCLE INVASIVE MICROPAPILLARY BLADDER CANCER: A MULTICENTER COLLABORATION BY THE EUROPEAN ASSOCIATION OF UROLOGY - YOUNG ACADEMIC UROLOGISTS

MP16-18 SURVIVAL OUTCOMES AFTER RADICAL CYSTECTOMY VERSUS CONSERVATIVE MANAGEMENT FOR T1 HIGH GRADE NON-MUSCLE INVASIVE MICROPAPILLARY BLADDER CANCER: A MULTICENTER COLLABORATION BY THE EUROPEAN ASSOCIATION OF UROLOGY - YOUNG ACADEMIC UROLOGISTS

PD51-03 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON PATHOLOGIC DOWNSTAGING IN PATIENTS WITH VARIANT HISTOLOGY UNDERGOING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-03 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON PATHOLOGIC DOWNSTAGING IN PATIENTS WITH VARIANT HISTOLOGY UNDERGOING RADICAL CYSTECTOMY Rebecca Campbell, Abhinav Khanna, Stephen Boorjian, Jacob Knorr, Roni Cox, Marlo Nicholas, Vidit Sharma, Prithvi Murthy, Robert Tarrell, Prabin Thapa, Matthew Tollefson, R. Houston Thompson, Igor Frank, R. Jeffrey Karnes, Georges-Pascal Haber, and Byron Lee Rebecca CampbellRebecca Campbell More articles by this author , Abhinav KhannaAbhinav Khanna More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Jacob KnorrJacob Knorr More articles by this author , Roni CoxRoni Cox More articles by this author , Marlo NicholasMarlo Nicholas More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Robert TarrellRobert Tarrell More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Igor FrankIgor Frank More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Variant histology (VH) bladder cancer is often associated with poor outcomes and the role of neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) in this population is poorly defined. The objective of this study was to determine if NAC results in similar pathologic downstaging at RC for patients with and without VH. METHODS: We retrospectively reviewed RC registries from two large tertiary referral centers and identified patients with pure or mixed VH (sarcomatoid, small cell carcinoma, nested, micropapillary and plasmacytoid) who underwent RC (1980-2018). Patients with VH were matched 1:2 with pure urothelial carcinoma patients by age, sex, pT-stage, pN-stage, and the receipt of NAC. The primary outcome was pathologic downstaging, defined as pT stage lower than cT stage. The differential impact of NAC on pathologic downstaging between VH and non-VH was assessed using a multivariable logistic regression with an interaction analysis. RESULTS: 889 patients were identified with median (IQR) follow-up of 4.39 (2.21-8.63) years, including 303 VH and 586 non-VH patients. Rates of clinical and pathologic ³T2 were: 239/303 (78.9%) and 286/303 (94.3%) in the VH cohort and 466/586 (79.5%) and 553/586 (94.3%) in the non-VH cohort, respectively. Overall, 68/889 (7.6%) patients experienced downstaging, including 28/153 (18.3%) patients who received NAC. The rates of downstaging after NAC for individual histologic subgroups were: 19 (19.0%) urothelial, 3 (33.3%) sarcomatoid, 0 (0%) small cell carcinoma, 2 (15.4%) nested, 3 (21.4%) micropapillary, and 1 (16.7%) plasmacytoid. The rates of downstaging in patients who did not receive NAC were: 22 (4.5%) urothelial, 4 (8.3%) sarcomatoid, 2 (3.5%) small cell carcinoma, 3 (7.5%) nested, 7 (9.3%) micropapillary, and 2 (6.7%) plasmacytoid. On multivariable analyses, NAC was associated with increased likelihood of downstaging in the overall cohort (OR 3.99, 95% CI 2.36-6.74, p<0.001) and this effect was not modified by VH vs non-VH histology (p=0.26 for interaction). CONCLUSIONS: The likelihood of downstaging following NAC for patients with VH is similar to that of matched urothelial controls, suggesting that NAC may have utility for VH patients. Future studies in larger cohorts of the individual variant histologies are warranted. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e906-e906 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Campbell More articles by this author Abhinav Khanna More articles by this author Stephen Boorjian More articles by this author Jacob Knorr More articles by this author Roni Cox More articles by this author Marlo Nicholas More articles by this author Vidit Sharma More articles by this author Prithvi Murthy More articles by this author Robert Tarrell More articles by this author Prabin Thapa More articles by this author Matthew Tollefson More articles by this author R. Houston Thompson More articles by this author Igor Frank More articles by this author R. Jeffrey Karnes More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Expand All Advertisement Loading ...

MP19-03 COMPARISON OF FACT-G SCORES WITH CANCER AND GENERAL POPULATION NORMS IN CANADIAN PATIENTS UNDERGOING RADICAL CYSTECTOMY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-03 COMPARISON OF FACT-G SCORES WITH CANCER AND GENERAL POPULATION NORMS IN CANADIAN PATIENTS UNDERGOING RADICAL CYSTECTOMY Julie Trudel, Ryan McLarty, and Conrad Maciejewski Julie TrudelJulie Trudel More articles by this author , Ryan McLartyRyan McLarty More articles by this author , and Conrad MaciejewskiConrad Maciejewski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Functional Assessment of Cancer Therapy-General (FACT-G) is often used as a generic measure in Health-Related Quality of Life (HRQOL) assessment among cancer patients. Its reference values relating to the general population and patients with different diseases are useful for the interpretation of HRQOL scores and allow a better understanding of the patients needs and HRQOL. No study to date has yet compared FACT-G normative data scores to those of Canadian patients undergoing radical cystectomy (RC) for bladder cancer. The objective of this study was to compare our patients pre-cystectomy FACT-G scores with US cancer and general population norms. METHODS: Patients were recruited from the Diana Wood Cancer Survivorship Clinic at The Ottawa Hospital between January 2019 and August 2020. HRQOL was evaluated by the FACT-G and raw scores were obtained for each FACT-G subscale, higher scores indicating better HRQOL. Effect sizes (ES-Hedge's g statistics), confidence intervals and minimal clinical significant differences (MCIDs) were used to compare pre FACT-G subscale scores with normative data. As suggested by current literature, a change of at least 5% to 10% within the instrument range was used as an estimate calculation of the MCID. RESULTS: 55 patients completed the FACT-G questionnaire before RC. The mean age was 67 years (SD: 10 years), 71% were male, 80% were in a married/common law partnership and 84% lived with someone. Overall, ES between pre-surgery FACT-G subscale scores and US cancer norms were small (ES≤0.2) and the MCIDs were less than 5% of change in the FACT-G measurement scale except for the dimension “Physical Well-Being” (ES=0.3, reported MCID value of 1.77, 6% of change). ES calculated between FACT-G scores and those from the US general population showed small effect sizes (ES≤0.2) for all FACT-G subscales except for the dimensions “Emotional Well-Being” (Medium ES=-0.56, reported MCID value of 2.7, 11% of change) and “Social Well-Being” (Medium ES=0.37, reported MCID value of 2.5, 9% of change). CONCLUSIONS: In our survivorship clinic, patients undergoing RC reported broadly similar FACT-G scores to US cancer population norms, with a notable exception of increased perceived “Physical Well-Being”. When comparing our data to US population norms, we once again showed similar scores on FACT-G subscales with the exception of decreased “Emotional Well-Being” and higher “Social Well-Being”. These results emphasize unique aspects of the bladder cancer survivorship experience, and highlight the value of patient reported assessment of HRQOL in RC patients. Source of Funding: The Diana Wood Bladder Cancer Survivorship Program © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e328-e328 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julie Trudel More articles by this author Ryan McLarty More articles by this author Conrad Maciejewski More articles by this author Expand All Advertisement Loading ...

MP57-07 PENILE PROSTHESIS COMPLICATIONS – ARE THEY MORE COMMON AFTER CYSTECTOMY? A MATCHED-COHORT ANALYSIS

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy (MP57)1 Sep 2021MP57-07 PENILE PROSTHESIS COMPLICATIONS – ARE THEY MORE COMMON AFTER CYSTECTOMY? A MATCHED-COHORT ANALYSIS Carlos Munoz-Lopez, Kevin Lewis, Molly Dewitt-Foy, Zaeem Lone, Drogo Montague, Kenneth Angermeier, and Bradley Gill Carlos Munoz-LopezCarlos Munoz-Lopez More articles by this author , Kevin LewisKevin Lewis More articles by this author , Molly Dewitt-FoyMolly Dewitt-Foy More articles by this author , Zaeem LoneZaeem Lone More articles by this author , Drogo MontagueDrogo Montague More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , and Bradley GillBradley Gill More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002087.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evaluate whether inflatable penile prosthesis (IPP) after radical cystectomy (RC) is associated with higher complication rates compared to IPP for other etiologies of erectile dysfunction (ED). METHODS: All IPPs within the past 20 years in a large regional health system were reviewed and ED etiology determined: RC, radical prostatectomy (RP), or organic/other ED (OED). Cohorts were generated by 1:3 propensity score match using age, body mass index, and diabetes status. Baseline demographics and relevant comorbidities were assessed. Clavien-Dindo complications and grade, as well as reoperation were assessed. Multivariable logarithmic regression with relevant variables identified predictors of 90-day complications. Kaplan-Meier analysis assessed time to reoperation after RC compared to other ED etiologies. RESULTS: Of 2600 patients identified, 231 matched for analyses. Demographic characteristics did not differ. Implantation of 3-piece devices was less common after RC (RC:64% vs. RP:90% vs. OED:94%, p <0.001), whereas ectopic reservoir placement was more common (RC:100% vs. RP:61% vs. OED:3%, p <0.001). Comparing RC vs pooled Non-RC indications, RC had a 4-fold greater complication rate (12% vs 3%, p=0.04) whereas complication rates did not significantly differ across specific ED etiologies (RC: 24% vs. RP: 8% vs. OED: 10%, p=0.06). Clavien-Dindo complication grades did not differ across groups. Regression showed 2-piece systems independently ‘protected’ against complication (OR: 0.3, p=0.03). Reoperation was significantly more common with RC (RC: 21% vs. non-RC: 7%, p=0.014) but time to reoperation did not differ by IPP indication (p=0.088). CONCLUSIONS: IPP is a valid option for radical cystectomy patients who historically benefitted from 2-piece systems, however contemporary low-profile reservoirs may expand the benefit of 3-piece devices to this patient population. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e980-e981 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Munoz-Lopez More articles by this author Kevin Lewis More articles by this author Molly Dewitt-Foy More articles by this author Zaeem Lone More articles by this author Drogo Montague More articles by this author Kenneth Angermeier More articles by this author Bradley Gill More articles by this author Expand All Advertisement Loading ...

PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY Jacob Knorr, Rebecca Campbell, Jarrod Dalton, Prithvi Murthy, Georges-Pascal Haber, and Byron Lee Jacob KnorrJacob Knorr More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Jarrod DaltonJarrod Dalton More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent efforts to optimize recovery following radical cystectomy have not led to substantial improvement in complication rates. Though clinical risk factors have been routinely studied, the contribution of socioeconomic factors has not been well-defined. The Area Deprivation Index (ADI) is derived from 17 U.S. Census variables in income, education, employment, and housing, and describes neighborhood disadvantage down to the geographic block-group (600-3,000 people). Our objective was to examine associations between ADI and perioperative outcomes following radical cystectomy. METHODS: A prospective database of radical cystectomy patients was queried from 2010-2018. Residential locations at time of surgery were geocoded using SQL Server with TIGER/LINE census data to assign a block-group for each patient. National ADI percentile ranks were imported from the Neighborhood Atlas. Patients were stratified by national ADI quartile with the 1st quartile representing least disadvantaged and 4th quartile the greatest disadvantaged. Outcomes were compared using Cochran Armitage Trend or Kruskal-Wallis tests. RESULTS: The distribution of 906 patients across ADI quartiles was: 12.7%, 31.8%, 35.1%, and 20.4%. The 4th quartile was associated with younger age (p=0.01), black race (p=<0.0001), and active smoking (p=<0.0001). The 90-day (90d) mortality rates observed in the 1st and 4th quartiles were 0% (0/115) and 6.5% (12/185), respectively. ADI quartile was significantly associated with 30d (p=0.01) and 90d (p=0.002) mortality. When evaluating ADI as a continuous variable, the unit and range odds ratios for 90d mortality were 1.021 (CI: 1.004 - 1.04) and 8.11 (CI: 1.5 - 47.83), respectively. ADI was also associated with late (30-90d) complications (p=0.04), though there were no significant differences in 30 and 90d major complications, readmission rates, or length of stay between ADI quartiles. CONCLUSIONS: We present the first use of the Area Deprivation Index at the block-group level in Urology. ADI was significantly associated with late complication and 30 and 90d mortality, with nearly half of all 90d deaths occurring in the most disadvantaged ADI quartile. Our findings suggest that post-cystectomy morbidity and mortality may be partially attributable to socioeconomic factors. Source of Funding: CWRU CCC © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e833-e833 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Knorr More articles by this author Rebecca Campbell More articles by this author Jarrod Dalton More articles by this author Prithvi Murthy More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Expand All Advertisement Loading ...

PD60-03 POST DISCHARGE NARCOTICS ARE UNNECESSARY FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making V (PD60)1 Sep 2021PD60-03 POST DISCHARGE NARCOTICS ARE UNNECESSARY FOLLOWING RADICAL CYSTECTOMY John Myrga, Michelle Yu, Jennifer Mihalo, David Miller, Maria Pere, Bruce Jacobs, and Benjamin Davies John MyrgaJohn Myrga More articles by this author , Michelle YuMichelle Yu More articles by this author , Jennifer MihaloJennifer Mihalo More articles by this author , David MillerDavid Miller More articles by this author , Maria PereMaria Pere More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002097.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies have shown that patients can be discharged following prostatectomy and nephrectomy without narcotics while maintaining adequate pain control. We sought to evaluate the feasibility of discharging radical cystectomy patients without narcotics. METHODS: We identified patients who underwent radical cystectomy from March through December 2020 at three hospitals within our major academic medical center. Demographic information, operative information, post-operative opioid prescribing, and post-discharge patient contact with the medical system were collected from electronic medical record review. RESULTS: We identified 107 patients, 32 discharged with a narcotic prescription (Mean Oral Morphine Equivalents Prescribed=116) and 75 discharged without. There were no differences in sex (p=0.60), preoperative opioid use (p=0.21), or open vs. robotic approach (p=1.00). Patients discharged without opioids were significantly older than those discharged with an opioid prescription (p <0.01). There was no difference in the percent of patients coming to the emergency department (p=0.82, Figure 1), being readmitted (p=0.37), calling the office (p=0.06), specific office calls regarding pain (p=0.72, Figure 1), or requests for new or refill narcotic prescriptions (p=0.16) within 30 days of discharge. There was no significant difference in the number of office visits (p=0.74, Figure 2). CONCLUSIONS: Patients can safely be discharged home without narcotics following cystectomy, regardless of robotic or open approach, reducing the incidence of opioid induced side effects as well as decreasing the risk of further perpetuating the opioid epidemic. Source of Funding: Bruce L. Jacobs, MD MPH is supported in part by the Shadyside Hospital Foundation. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1061-e1061 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Myrga More articles by this author Michelle Yu More articles by this author Jennifer Mihalo More articles by this author David Miller More articles by this author Maria Pere More articles by this author Bruce Jacobs More articles by this author Benjamin Davies More articles by this author Expand All Advertisement Loading ...

Effects of Lymphovascular Invasion on Overall and Cancer-specific Survival after Radical Cystectomy in Patients with Bladder Cancer

Effects of Lymphovascular Invasion on Overall and Cancer-specific Survival after Radical Cystectomy in Patients with Bladder Cancer

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

Purpose: This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. Methods: A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). Results: The surgical technique was significantly related to the number of complications (p < 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (p < 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (p < 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. Conclusions: The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

The development of the Cystectomy-Pathway Assessment Tool (C-PAT): a concise tool to assess the quality of care in the cystectomy pathway.

To develop and test the psychometric properties of a concise, patient-reported questionnaire, designed to assess key aspects of the radical cystectomy (RC) patient pathway that are important to both patients and clinicians. Draft items were developed by a consultation with a 13-member expert clinical panel, and the in-depth qualitative analysis of 14 semi-structured interviews with patients who had received RC within the previous 18 months. A further nine cognitive interviews with patients refined the items and ensured they were easy to complete. Pilot testing in 122 patients recruited from five hospitals in England tested the properties of validity and reliability of the resulting 17-item questionnaire. Patients and clinicians identified the following aspects as important for the delivery of quality patient care. These included timely referral and initial test results; an explanation of risk/benefits of treatment; access to a cancer nurse specialist; training and support in stoma management; timely surgery, surgical complications, and timely follow-up. Pilot testing showed missing data was low (≤3% for all items), and between 73% and 89% of the responses to items were the most positive about their care (indicating ceiling effects). Five items were identified using factor analysis as being statistically related (Cronbach's α 0.76, intraclass correlation coefficient test-retest reliability of 0.95) and formed the scored part of the tool 'care and support', scored 0-16. There was insufficient evidence at this stage to show the tool was capable of measuring differences between cancer centres. We have developed a questionnaire that captures aspects of quality of care within the RC patient pathway. The results support the validity and reliability of the 17-item Cystectomy-Pathway Assessment Tool (C-PAT). We envisage the tool can be the basis for audit of the patient reported assessment of the quality of care for individual cancer centres.

A comparative study of perioperative and survival outcomes of robot-assisted radical cystectomy in patients over 80 and under 80 years old

BackgroundRadical cystectomy (RC) is the standard treatment for bladder cancer, but the safety and efficacy of this treatment for elderly people need to be considered. We compare perioperative data and survival outcomes between elderly (≥80 years) and younger (<80 years) patients undergoing robot-assisted radical cystectomy (RARC).MethodsWe reviewed demographic, perioperative clinical and follow-up data of 190 consecutive patients with urothelial carcinoma of bladder who received RARC from May 2015 to December 2018 in Nanjing Drum Tower Hospital. The patients were divided into 2 groups by age: ≥80 years and <80 years. Perioperative outcomes were compared between 2 groups. Logistic regression method was used to analyze the factors that may affect preoperative complications. Cox regression model was employed to analyze the factors affecting 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS).ResultsOf the 190 patients, 44 (23.2%) were octogenarians. The elderly patients did not statistically differ from younger patients in most of the demographic, perioperative, and pathological information. American Society of Anesthesiologists (ASA) score (p=0.045) and Charlson comorbidity index (CCI) (p=0.035) could predict high-grade and any grade complications, respectively. Positive lymph node and pT≥3 were main factors affecting OS, RFS, and CSS. ASA score (p=0.048) and CCI (p=0.003) could predict OS and RFS, respectively. Elderly group had worse OS (p=0.007) and CSS (p=0.027) but similar RFS (p=0.147) compared with younger group.ConclusionThe elderly who received RARC had similar risk of perioperative complications and RFS compared with younger patients. RARC could be an alternative treatment for selected octogenarians.