Surgery For Bladder Cancer Research Articles

The Effect of Spinal and General Anesthesia on Metastatic Lymph Node Flow in Bladder Cancer Surgery: A Pilot Study.

The sympathetic regulation of contractile function of lymphatic vessels has received much attention in terms of metastasis mechanism nowadays in animal studies. The aim of the study to evaluate the effect of spinal or general anesthesia on flow in malignant lymph nodes in patients undergoing bladder tumor surgery with doppler ultrasound. This prospective, observational, pilot study was performed on the patients (ASA II and III, aged 45-85) who scheduled for elective bladder tumor surgery under spinal or general anesthesia from July 2018 to August 2019. Patients were divided into two groups, spinal anesthesia and general anesthesia. Resistivity index, pulsatility index, peak systolic velocity and end diastolic velocity measurements were recorded preoperatively and postoperatively n the inguinal lymph nodes by doppler ultrasound. In the malignant lymph nodes, the pulsatility index value decreased with the spinal anesthesia (n=12) compared to the preoperative period (p = 0.002) but increased in the general anesthesia group (n=11) (p = 0.003). There was a significant difference in postoperative pulsatility index between the two groups (p = 0.0001) (cut off => 5.49, sensitivity 81.82%, specificity 91.67%). Postoperative peak systolic velocity values were significantly higher than preoperative values only in general anesthesia group (p = 0.021). Lymphatic flow in metastatic lymph nodes decreased by spinal anesthesia compared to general anesthesia evaluated by using doppler ultrasound in our study. Although this new mechanism is new in the reduction of lymphatic metastasis during cancer surgery, prospective randomized studies evaluating long-term recurrence and survival are warranted.

Association between perioperative glucocorticoids and cancer metastasis and survival in patients undergoing radical cystectomy for urothelial carcinoma of the bladder: A single-center retrospective study.

PurposePerioperative glucocorticoids have the potential to increase the risk of tumor metastasis. However, the relationship between perioperative glucocorticoids and oncologic outcomes remains controversial. The present study was undertaken to evaluate the association of perioperative glucocorticoids with clinicopathologic outcomes following radical cystectomy (RC).Materials and MethodsWe screened and included 185 patients who underwent radical surgery for bladder cancer in our center between 2009 and 2018. The Kaplan–Meier method was applied, and a log-rank test was used to estimate differences in metastasis-free survival (MFS) and overall survival (OS) between the groups. Multivariate Cox proportional hazards regression models were used to analyze any association of glucocorticoids with clinical outcomes.ResultsA total of 76 (41.1%) patients received perioperative glucocorticoids. Median postoperative follow-up was 2.0 years. Kaplan–Meier survival curve indicated that the glucocorticoids group was significantly associated with increased distant MFS (p=0.008) but not with OS. In the multivariate analysis, no significant differences were observed for MFS between the groups. Interestingly, when the variable of blood transfusion was excluded from the multivariate analysis model, we found that patients receiving glucocorticoids were independently associated with worse MFS (hazard ratio, 1.790; p=0.030). Furthermore, the partial correlation analysis showed a significant positive correlation between perioperative glucocorticoids and blood transfusion (r=0.604, p<0.001). In the nontransfusion subgroup, propensity score matching showed that patients receiving glucocorticoids had a higher risk of distant metastasis.ConclusionsPerioperative glucocorticoids were associated with a higher rate of distant metastasis in patients undergoing RC for bladder cancer.

The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis

INTRODUCTION: Data investigating the role of regional anesthesia on survival in bladder cancer is lacking. This retrospective study aimed to compare the impact of regional anesthesia and general anesthesia on survival in patients who underwent surgery for bladder cancer. METHODS: A total of 181 patients (mean age 62±11 years, 82 % male) who underwent surgery for bladder cancer were enrolled in this retrospective study. All data were collected from patient case charts. Patients were divided into two study groups according to the type of anesthesia used: Regional anesthesia group (RA Group) (n=120) and general anesthesia group (GA Group) (n=61). RESULTS: Three-years survival following surgery was significantly higher in patients receiving regional anesthesia compared to those receiving general anesthesia (96.6% vs. 86.8%, p=0.012). Logistic regression analyses showed that postoperative infection (OR: 0.221, 95 % CI: 0.065-0.754, p=0.016) and implementation of regional anesthesia (OR: 4.275, 95 % CI: 1.230-14.852, p=0.020) were predictive for 3-years survival. DISCUSSION AND CONCLUSION: Findings of the present study demonstrate that regional anesthesia provides better 3-year survival compared to general anesthesia in patients undergoing surgery for bladder cancer. Postoperative infections and anesthesia technique are the predictors of survival in these patients.

Extended versus non-extended lymphadenectomy during radical cystectomy for patients with bladder cancer: a meta-analysis of the effect on long-term and short-term outcomes

BackgroundPelvic lymphadenectomy (PLND) is an integral part of curative surgery for high-risk non-muscle invasive and muscle-invasive bladder cancer. The therapeutic value of extended PLND is controversial.MethodsWe conducted a comprehensive online search in PubMed, EMBASE, and the Cochrane Library databases for relevant literature directly comparing extended PLND (e-PLND) with non-extended PLND (ne-PLND) from database inception to June 2019. We performed the meta-analysis to evaluate the impact of PLND templates on recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), rates of postoperative major complications, and mortality within 90 days of surgery.ResultsA total of 10 studies involving 3979 patients undergoing either e-PLND or ne-PLND were included. The results showed that e-PLND was significantly associated with better RFS (HR 0.74, 95% CI 0.62–0.90, p = 0.002) and DSS (HR 0.66, 95% CI 0.55–0.79, p < 0.001). However, no correlation was found between e-PLND template and a better OS (HR 0.93, 95% CI 0.55–1.58, p = 0.79). Postoperative major complications were similar between e-PLND group and ne-PLND group, as was mortality within 90 days of surgery.Conclusione-PLND template is correlated with favorable RFS and DSS outcomes for patients with bladder cancer. e-PLND did not have more postoperative major complications than did ne-PLND.

Supplementary granulocyte macrophage colony-stimulating factor to chemotherapy and programmed death-ligand 1 blockade decreases local recurrence after surgery in bladder cancer.

Despite advances and refinements in surgery and perioperative chemotherapy, there are still unmet medical needs with respect to radical cystectomy for muscle‐invasive bladder cancer (MIBC). We investigated the potential benefit of supplementary granulocyte macrophage colony‐stimulating factor (GM‐CSF) to chemoimmunotherapy with programmed cell death protein‐1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) axis blockade and standard neoadjuvant chemotherapy in bladder cancer. We inoculated 2 × 105 MBT2 cells s.c. in C3H mice to create a syngeneic animal model of local recurrence (LR). When the tumor diameter reached 12 mm, the mice were allocated randomly as follows: (i) non‐treated control (vehicle only); (ii) anti‐mPD‐L1 monotherapy; (iii) mGM‐CSF monotherapy; (iv) anti‐mPD‐L1 plus mGM‐CSF; (v) gemcitabine and cisplatin (GC); (vi) GC plus anti‐mPD‐L1; (vii) GC plus mGM‐CSF; and (viii) GC plus anti‐mPD‐L1 plus mGM‐CSF. After completing 2‐week neoadjuvant therapy, tumors were resected for resection margin evaluation and immunohistochemical staining and blood was collected for flow cytometry and ELISA. Operative wounds were sutured, and the operative site was monitored to detect LR. Addition of anti‐mPD‐L1 and mGM‐CSF to neoadjuvant GC chemotherapy enhanced the antitumor effect and reduced positive resection margins (50% vs 12.5%). Combination of GC, anti‐mPD‐L1, and mGM‐CSF resulted in longer LR‐free survival and cancer‐specific survival compared to those in other groups. These effects involved an immunotherapy‐related decrease in oncological properties such as tumor invasion capacity and epithelial‐mesenchymal transition. mGM‐CSF significantly decreased the accumulation of myeloid‐derived suppressor cells in both the blood and tumor microenvironment and blood interleukin‐6 levels. Supplementary GM‐CSF to neoadjuvant GC plus PD‐L1 blockade could decrease LR after radical surgery by immune modulation in the blood and tumor microenvironment.

Perioperative nutrition for the treatment of bladder cancer by radical cystectomy.

Radical cystectomy (RC) is the primary surgical treatment for muscle-invasive urothelial carcinoma of the bladder. This major operation is typically associated with an extended hospital stay, a prolonged recovery period and potentially major complications. Nutritional interventions are beneficial in some people with other types of cancer and may be of value in this setting too.To assess the effects of perioperative nutrition in people undergoing radical cystectomy for the treatment of bladder cancer.We performed a comprehensive search using multiple databases (Evidence Based Medicine Reviews, MEDLINE, Embase, AMED, CINAHL), trials registries, other sources of grey literature, and conference proceedings published up to 22 February 2019, with no restrictions on the language or status of publication.We included parallel-group randomised controlled trials (RCTs) of adults undergoing RC for bladder cancer. The intervention was any perioperative nutrition support.Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias and the quality of evidence using GRADE. Primary outcomes were postoperative complications at 90 days and length of hospital stay. The secondary outcome was mortality up to 90 days after surgery. When 90-day outcome data were not available, we reported 30-day data.The search identified eight trials including 500 participants. Six trials were conducted in the USA and two in Europe.1. Parenteral nutrition (PN) versus oral nutrition: based on one study with 157 participants, PN may increase postoperative complications within 30 days (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.07 to 1.82; low-quality evidence). We downgraded the quality of evidence for serious study limitations (unclear risk of selection, performance and selective reporting bias) and serious imprecision. This corresponds to 198 more complications per 1000 participants (95% CI 35 more to 405 more). Length of hospital stay may be similar (mean difference (MD) 0.5 days higher, CI not reported; low-quality evidence).2. Immuno-enhancing nutrition versus standard nutrition: based on one study including 29 participants, immuno-enhancing nutrition may reduce 90-day postoperative complications (RR 0.31, 95% CI 0.08 to 1.23; low-quality evidence). These findings correspond to 322 fewer complications per 1000 participants (95% CI 429 fewer to 107 more). Length of hospital stay may be similar (MD 0.20 days, 95% CI 1.69 lower to 2.09 higher; low-quality evidence). We downgraded the quality of evidence of both outcomes for very serious imprecision.3. Preoperative oral nutritional support versus normal diet: based on one study including 28 participants, we are very uncertain if preoperative oral supplements reduces postoperative complications. We downgraded quality for serious study limitations (unclear risk of selection, performance, attrition and selective reporting bias) and very serious imprecision. The study did not report on length of hospital stay.4. Early postoperative feeding versus standard postoperative management: based on one study with 102 participants, early postoperative feeding may increase postoperative complications (very low-quality evidence) but we are very uncertain of this finding. We downgraded the quality of evidence for serious study limitations (unclear risk of selection and performance bias) and very serious imprecision. Length of hospital stay may be similar (MD 0.95 days less, CI not reported; low-quality evidence). We downgraded the quality of evidence for serious study limitations (unclear risk of selection and performance bias) and serious imprecision.5. Amino acid with dextrose versus dextrose: based on two studies with 104 participants, we are very uncertain whether amino acids reduce postoperative complications (very low-quality evidence). We are also very uncertain whether length of hospital stay is similar (very low-quality evidence). We downgraded the quality of evidence for both outcomes for serious study limitations (unclear and high risk of selection bias; unclear risk of performance, detection and selective reporting bias), serious indirectness related to the patient population and very serious imprecision.6. Branch chain amino acids versus dextrose only: based on one study including 19 participants, we are very uncertain whether complication rates are similar (very low-quality evidence). We downgraded the quality of evidence for serious study limitations (unclear risk of selection, performance, detection, attrition and selective reporting bias), serious indirectness related to the patient population and very serious imprecision. The study did not report on length of hospital stay.7. Perioperative oral nutritional supplements versus oral multivitamin and mineral supplement: based on one study with 61 participants, oral supplements compared to a multivitamin and mineral supplement may slightly decrease postoperative complications (low-quality evidence). These findings correspond to 135 fewer occurrences per 1000 participants (95% CI 256 fewer to 65 more). Length of hospital stay may be similar (low-quality evidence). We downgraded the quality of evidence of both outcomes for study limitations and imprecision.Based on few, small and dated studies, with serious methodological limitations, we found limited evidence for a benefit of perioperative nutrition interventions. We rated the quality of evidence as low or very low, which underscores the urgent need for high-quality research studies to better inform nutritional support interventions for people undergoing surgery for bladder cancer.

Preoperative predictors of early death risk in bladder cancer patients treated with robot-assisted radical cystectomy.

BackgroundEarly identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients.MethodsA total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected.ResultsMedian follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC.ConclusionAge and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.

Current role of robotic bladder cancer surgery.

Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC. A non-systematic review on all relevant studies with the keywords "Radical cystectomy," "Open," "Robot-assisted," "Complications," "Recurrence," "Survival," "Neobladder," "Potency," "Continence" and "Intracorporeal" was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines. RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique. As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects.

64 - Combined minimal invasive surgery for bladder cancer and another intra-abdominal malignancy: A single centre experience

64 - Combined minimal invasive surgery for bladder cancer and another intra-abdominal malignancy: A single centre experience

An improved ileal conduit surgery for bladder cancer with fewer complications

BackgroundRadical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer. Although this approach prolongs patient survival remarkably, there are postoperative complications associated with urinary diversion. This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma- and ureteroileal anastomosis-related complications, as compared with conventional ileal conduit urinary diversion.MethodsWe retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1, 2000 and June 30, 2016. Ileal conduit was created by the conventional or a modified technique. The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test. Multivariable logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma- and ureteroileal anastomosis-related complications in the two groups.Results145 and 100 patients underwent the modified and conventional ileal conduit surgery, respectively. The two groups were comparable with regard to clinicopathologic features. The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group (0.7% vs. 17.0%, P < 0.001). No late stoma-related complications were seen in the modified ileal conduit group, but were seen in 13 (13.0%) patients in the conventional ileal conduit group. The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group (4.8% vs. 15.0%, P = 0.001). In multivariable analyses, the modified ileal conduit group was significantly less likely to develop stoma- (odds ratio [OR] = 0.024, 95% confidence interval [CI] 0.003–0.235; P = 0.001) or ureteroileal anastomosis-related complications (OR = 0.141, 95% CI 0.042–0.476; P = 0.002) than the conventional ileal conduit group.ConclusionsOur modified surgical technique for ileal conduit urinary diversion may be effective for reducing early and late complications related to the stoma and the ureteroileal anastomosis. Prospective randomized clinical trials are needed to confirm our results.

Simulation in Transurethral Bladder Cancer Surgery

Simulation in Transurethral Bladder Cancer Surgery

Testing the Utilization of a Mobile Health App for Patients Undergoing Cystectomy Surgery for Bladder Cancer

Testing the Utilization of a Mobile Health App for Patients Undergoing Cystectomy Surgery for Bladder Cancer

Continuous rectus sheath block in a patient with a postoperative rectus sheath hematoma: a case report

BackgroundSevere abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient’s activities of daily living. A case of postoperative RSH for which a continuous rectus sheath block (RSB) was effective is reported.Case presentationA 62-year-old woman who had no previous medical history underwent hysterectomy, total cystectomy, and ileal conduit surgery for bladder cancer under epidural and general anesthesia. She complained of severe abdominal pain 40 min after removal of the epidural catheter on postoperative day (POD) 4. Computed tomography showed an RSH on POD 12. For pain relief, an ultrasound-guided continuous RSB was performed on POD 17. After the block, the numerical rating scale (NRS) score during movement decreased immediately (from 10 to 2 or 3), and she had no further need for oral or intravenous analgesics. She was discharged from the hospital without any complications on POD 28.ConclusionsContinuous RSB can be an effective technique for pain relief of postoperative RSH.

Factors related to patient choice of bladder reconstruction following radical cystectomy

Objective: To identify patient values and concerns related to choice of bladder reconstruction following removal, in order to provide understanding of factors important in making surgical decisions. Subjects and methods: Sixty-two patients treated for advanced bladder cancer (grade pT1 and above), and choosing either ileal conduit or orthotopic neobladder following cystectomy, each completed three questionnaires: European Organization for Research and Treatment quality of life questionnaire; bladder reconstruction satisfaction questionnaire; and life values inventory. Results: Health status (European Organization for Research and Treatment quality of life questionnaire) was not related to procedure satisfaction. Older, and female, patients had ileal conduit. Ileal conduit patients rated ease of postoperative maintenance, and perceived ease of surgery, as more important; neobladder patients rated returning to normality as more important (bladder reconstruction satisfaction questionnaire). Ileal conduit patients had higher life values (life values inventory) concerning environment, humility and loyalty; while neobladder patients had higher values concerning creativity, independence and science. Conclusion: Pre-existing concerns influence choices that patients make between ileal conduit and neobladder after removal of their bladder. Those wanting to minimise surgical difficulty and extra work following the reconstruction, and valuing living their life with regard to others, favour ileal conduit. Patients being younger, male, valuing the way they lived their life preoperatively, and valuing science/technology, favour neobladder. These findings are a stepping stone towards developing a tool to aid joint patient/consultant decision-making, when planning reconstructive surgery for bladder cancer. Level of evidence: Not applicable for this multicentre audit.

Leveraging Latent Dirichlet Allocation in processing free-text personal goals among patients undergoing bladder cancer surgery.

As we begin to leverage Big Data in health care settings and particularly in assessing patient-reported outcomes, there is a need for novel analytics to address unique challenges. One such challenge is in coding transcribed interview data, typically free-text entries of statements made during a face-to-face interview. Latent Dirichlet Allocation (LDA) offers statistical rigor and consistency in automating the interpretation of patients' expressed concerns and coping strategies. LDA was applied to interview data collected as part of a prospective, longitudinal study of QOL in N = 211 patients undergoing radical cystectomy and urinary diversion for bladder cancer. LDA analyzed personal goal statements to extract the latent topics and themes, stratified by time, and on things patients wanted to accomplish and prevent. Model comparison metrics determined the number of topics to extract. LDA extracted seven latent topics. Prior to surgery, patients' priorities were primarily in cancer surgery and recovery. Six months after the surgery, they were replaced by goals on regaining a sense of normalcy, to resume work, to enjoy life more fully, and to appreciate friends and family more. LDA model parameters showed changing priorities, e.g., immediate concerns on surgery and resuming employment decreased post-surgery and were replaced by concerns over cancer recurrence and a desire to remain healthy and strong. Novel Big Data analytics such as LDA offer the possibility of summarizing personal goals without the need for conventional fixed-length measures and resource-intensive qualitative data coding.

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies.

The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.

Bladder sparing surgery in high-grade bladder cancer.

The gold standard for managing muscle-invasive bladder cancer is radical cystectomy (RCE). The RCE is a treatment, which carries high burden of perioperative morbidity and mortality. As biomolecular markers make muscle-invasive high-grade bladder cancer(HGBC) an entity different from non-invasive papillary disease, we tested a hypothesis that alternative bladder preserving surgery(BPS) approaches, such as partial cystectomy and transurethral resection of the bladder would not compromise the oncological results of treating HGBC in selected patients.Aim:To study the cancer specific survival of HGBC patients depending on the mode of surgical treatment- RCE, partial en-block cystectomy, and transurethral resection of the bladder in the practice of the Departments of Urology and Oncology of Bogomolets National Medical University, and to assess the prevalence of bladder sparing surgical management of HGBC in local practice as a part of trimodal treatment approach to bladder preservation.Materials and Methods: Retrospectively we studied the medical records of 3597urothelial bladder cancer patients, of whom 346 (10%) had high-grade disease and who underwent surgical treatment in 2004-2017. All patients were studied with contact computed tomography of the chest, abdomen, pelvis, and biopsy of the tumor. Based on the results of the diagnostic workup the choice of surgical treatment between RCE, partial cystectomy and transurethral resection was made considering the size of the tumor, location of the tumor in the bladder in relation to the bladder neck, and technical and oncological feasibility of performing the bladder sparing surgery. Kaplan- Meier survival curves were built to compare the results of survival per cancer stage and type of surgical treatment. Survival data of the patients were collected from the cancer registry maintained at the Kyiv Municipal Clinical Oncological Center. Results of data analysis were controlled for confounding parameters, such as adjuvant treatment: perioperative radiotherapy, and chemotherapy.Results: Median follow-up was 93months (1-226months). Males were 276 (80%). Average age at diagnosis was 62±4.5years. By the time of the study 61% of patients have died due to the progression of the disease. All patients with stage I disease (7% or 24patients) were managed with bladder-sparing surgery. In muscle-invasive disease (309patients), the RCE was performed in 109 (35.3%) patients, partial cystectomy was performed in 79 (25.6%) patients, and transurethral resection- in 121 (39.1%) patients. The overall 5-year survival of HGBC patients after radical surgical treatment (RCE/BPS) for stage I patients was 0%/83%, for stage II- 43%/58%, for stage III- 37%/42%, and for stage IV- 10%/40%. Atotal of 44patients (12.7% of all treated, and 19.6% of treated with bladder sparing) received postoperative radiotherapy after bladder-sparing surgery. Atotal of 14patients (4% of all treated) received postoperative chemotherapy.Conclusion: Bladder sparing surgery (partial en-block cystectomy, and transurethral resection of the bladder) in selected patients is not inferior to RCE in terms of cancer-specific survival when treating patients with HGBC of all stages. The bladder sparing surgery was performed in 64.7% of patients with high grade bladder cancer. Utilization of adjuvant treatment is low, 12.7% for postoperative radiotherapy, and 4% for perioperative chemotherapy.

Virtual Reality and Simulation for Progressive Treatments in Urology

In urology technologies and surgical practices are constantly evolving and virtual reality (VR) simulation has become a significant supplement to existing urology methods in the training curricula of urologists. However, new developments in urology also require training and simulation for a wider application. In order to achieve this VR and simulation could play a central role. The purpose of this article is a review of the principal applications for VR and simulation in the field of urology education and to demonstrate the potential for the propagation of new progressive treatments. Two different cases are presented as examples: exposure therapy for paruresis and virtual cystoscopy for diagnosis and surgery of bladder cancer. The article uses research and publications listed in openly accessible directories and is organized into 3 sections: The first section covers features of VR and simulation technologies. The second one presents confirmed applications of current technologies in urology education and showcases example future applications in the domain of bladder treatment and surgery. The final section discusses the potential of the technology to improve health care quality.

Surgery in incidental gall bladder cancer – significance of residual disease

Surgery in incidental gall bladder cancer – significance of residual disease

What drives centralisation in cancer care?

BackgroundTo improve quality of care, centralisation of cancer services in high-volume centres has been stimulated. Studies linking specialisation and high (surgical) volumes to better outcomes already appeared in the 1990’s. However, actual centralisation was a difficult process in many countries. In this study, factors influencing the centralisation of cancer services in the Netherlands were determined.Material and methodsCentralisation patterns were studied for three types of cancer that are known to benefit from high surgical caseloads: oesophagus-, pancreas- and bladder cancer. The Netherlands Cancer Registry provided data on tumour and treatment characteristics from 2000–2013 for respectively 8037, 4747 and 6362 patients receiving surgery. By plotting timelines of centralisation of cancer surgery, relations with the appearance of (inter)national scientific evidence, actions of medical specialist societies, specific regulation and other important factors on the degree of centralisation were ascertained.ResultsFor oesophagus and pancreas cancer, a gradual increase in centralisation of surgery is seen from 2005 and 2006 onwards following (inter)national scientific evidence. Centralisation steps for bladder cancer surgery can be seen in 2010 and 2013 anticipating on the publication of norms by the professional society. The most influential stimulus seems to have been regulations on minimum volumes.ConclusionScientific evidence on the relationship between volume and outcome lead to the start of centralisation of surgical cancer care in the Netherlands. Once a body of evidence has been established on organisational change that influences professional practice, in addition some form of regulation is needed to ensure widespread implementation.