High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients

Korkes, Fernando; Palou, Juan

doi:10.1590/s1677-5538.ibju.2019.06.03

Cited by 11 publications

(18 citation statements)

References 24 publications

(40 reference statements)

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“…( 20 , 22 ) More experienced centers and healthcare professionals are expected to perform an adequate pre-surgical management considering life expectancy and comorbidities, and might acknowledge that some patients benefit from less aggressive surgical strategies, such as ureterostomy rather the use of intestinal segments for urinary diversion. ( 26 ) Unfortunately, while this reality does not change, we will continue to observe a scarcity of published data on BC and RC from our country, because outcomes remain poor and with an exceedingly high mortality rate observed.…”

Section: Discussionmentioning

confidence: 99%

“…( 20 , 22 ) Instituições e profissionais de saúde mais experientes muito provavelmente realizam um tratamento pré-cirúrgico adequado, considerando a expectativa de vida e as comorbidades, e podem reconhecer que alguns pacientes se beneficiam de estratégias cirúrgicas menos agressivas, como a ureterostomia, em vez de uso de segmentos intestinais para a derivação urinária. ( 26 ) Infelizmente, enquanto essa realidade não mudar, continuaremos a observar escassez de dados publicados de nosso país sobre CB e CR, uma vez que os resultados permanecem ruins e com taxa de mortalidade extremamente alta.…”

Section: Discussionunclassified

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Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

Korkes

Cunha

Nascimento

et al. 2020

Einstein (São Paulo)

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Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy / year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

Korkes

Cunha

Nascimento

et al. 2020

Einstein (São Paulo)

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“…Natural history of bladder cancer is dreadful, with 38% patients develop metastasis after 6 months if untreated, and only 5% patients would survive after 5 years [ 16 , 17 ]. Radical cystectomy is the standard treatment for muscle invasive bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

Comparison of survival in elderly patients treated with uretero-cutaneostomy or ileal conduit after radical cystectomy

Huang

Chen

et al. 2021

BMC Geriatr

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Background In bladder cancer patients with age ≥ 80 years old, there have been controversies in performing uretero-cutaneostomy or ileal conduit as urinary diversion after radical cystectomy. Limited study evaluated overall survival (OS) and cancer-specific survival (CSS) between the two urinary diversions in elderly patients. This study is to compare OS and CSS between uretero-cutaneostomy and ileal conduit after radical cystectomy in bladder cancer patients with age ≥ 80 years old. Patients and methods Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Bladder cancer patients diagnosed between 2004 and 2016 with age ≥ 80 years old who underwent radical cystectomy with either UC or IC were selected. After propensity score matching, Cox regression and Kaplan-Meier analysis were used to analyze the survival. We calculated statistical power for survival. Results Of 1394 patients who met the inclusion criteria, 1093 underwent ileal conduit and 301 underwent uretero-cutaneostomy. After propensity score matching, 285 patients were included in each group. Multivariable Cox analysis showed urinary diversion was not a risk factor of OS and CSS (HR 1.044, [95% CI 0.867–1.257] and 1.012 [0.748–1.368], respectively). Both OS and CSS were not significantly different, with median survival of ileal conduit and uretero-cutaneostomy were 19 [16–24] months and 19 [15–26] months respectively. Additionally, We found OS had the following risk factors: tumor stage (distant vs regional vs localized, 5.332 [3.610–7.875] vs 1.730 [1.375–2.176] vs 1), node density (>0.2 vs ≤0.2 vs none, 1.410 [1.047–1.898] vs 0.941 [0.658–1.344] vs 1) and age (1.067 [1.032–1.103] for each year). While CSS had the following risk factors: tumor stage (distant vs regional vs localized, 4.035 [2.046–7.959] vs 2.476 [1.651–3.713] vs 1), node density (>0.2 vs ≤0.2 vs none, 2.501 [1.645–3.804] vs 1.062 [0.590–1.914] vs 1) and tumor size (greater than 3 cm vs less than 3 cm, 1.596 [1.057–2.412] vs 1). Our analysis obtained 0.707 power for overall survival. Conclusion Urinary diversion by uretero-cutaneostomy or by ileal conduit was not associated with overall and cancer-specific survival. It is reasonable to consider uretero-cutaneostomy as a regular procedure of urinary diversion in elderly bladder cancer patients after radical cystectomy to avoid associate complications.

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“…Bladder Cancer (BC) is not a very common malignancy. In Brazil, there are 10.640 new cases estimated for 2020, representing 1.6% of all malignancies (1,2). In Brazil, aging population has been associated with a significant increment in the number of patients with BC during the last decade (3).…”

Section: Bc Number and Treatment Advancesmentioning

confidence: 99%

Increasing costs from bladder cancer in the Brazilian Health System: the role of establishing public health policies

Korkes

Maluf

2021

Int. braz j urol.

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High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients

Cited by 11 publications

References 24 publications

Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

Comparison of survival in elderly patients treated with uretero-cutaneostomy or ileal conduit after radical cystectomy

Increasing costs from bladder cancer in the Brazilian Health System: the role of establishing public health policies

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