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

Korkes, Fernando; Cunha, Frederico Timóteo Silva; Nascimento, Matheus Prado; Rodrigues, Antônio Flávio Silva; Baccaglini, Willy; Glina, Sidney

doi:10.31744/einstein_journal/2020ao5628

Cited by 5 publications

(3 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Aware that patients treated with radical cystectomy frequently died, we decided to conduct national studies to gather epidemiologic data [1] and study our region. We found an astonishing 90-day mortality rate of 37% after radical cystectomy in the public hospitals of our region [2].…”

mentioning

confidence: 57%

The CABEM Initiative: Saving Patients With Muscle-invasive Bladder Cancer

Korkes¹,

Santiago²,

Peixoto³

et al. 2022

Société Internationale D’Urologie Journal

View full text Add to dashboard Cite

Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralized program involving a multidisciplinary clinic in a region comprising 7 municipalities. Helping patients with adequate performance status get the right treatment helped to reduce 90-day mortality after radical cystectomy from 37% to 1.9%.

show abstract

mentioning

confidence: 57%

The CABEM Initiative: Saving Patients With Muscle-invasive Bladder Cancer

Korkes¹,

Santiago²,

Peixoto³

et al. 2022

Société Internationale D’Urologie Journal

View full text Add to dashboard Cite

show abstract

“…The gold standard curative option, radical cystectomy is considered as a surgery with high morbidity and mortality [16]. Excluding high volume specialized centers the mortality and morbidity rates are comparable in many parts of the world.…”

Section: Surgical Management and Complicationsmentioning

confidence: 99%

Prospective analysis of a radical cystectomy series at a tertiary care center in Sri Lanka –is there room to improve the outcome?

et al. 2023

View full text Add to dashboard Cite

IntroductionBladder cancer (BC) is a common malignancy and ranks tenth globally. Radical cystectomy remains the gold standard for organ confined muscle invasive bladder cancer (MIBC). It has proven efficacy on local disease control and tumour free survival (TFS). Notwithstanding the improvement of techniques and peri-operative care, this procedure is associated with high peri-operative morbidity. Despite the abundance of descriptive studies on demography there are only a few local studies published on the long-term outcome of surgical treatment. Present analysis of radical cystectomy series with minimum 3-year follow up will fill the gap in literature as first reported long-term study in the local setting Methodology Twenty-six consecutive cystectomies performed over two years from April 2016 at a single tertiary center were prospectively analysed for demography peri-operative and long-term outcome. Median follow-up was 43.5 months. ResultsMedian age was 60 (range 35-74) years. Ninety-two percent were males. Twenty-two out of 26 (85%) were presented with haematuria. Eighty-one percent (21/26) had urothelial bladder cancer (UBC) out of which, 77% (20/26) were males with a mean age of 59.6years. Four out of five who had nonurothelial bladder cancer (NUBC) were males. Fourty-two percent (11/26) were smokers and death percentage was markedly high among smokers than nonsmokers. No other known risk factors were identified among the rest. Thirty-eight-point five percent (10/26) were pT3b and pT4a, while 53.8% (14/26) were pT3 or above tumours.Majority (62%) of complications fell into minor category (Clavien-I/II) with an average blood loss of 850 ml and a transfusion rate of 15% (4/26).Thirty day and 90day mortality rates were 3.8% and 7.7% respectively rising to one-year mortality of 23%. Four out of twenty-six cystectomy operations were done for palliation. Three-year overall survival (OS) was 61% [CI 41.5% -79.7%]. Out of the 12 deaths, 8 (67%) were due to cancer progression while 4 had local recurrences. Among the patients who were cancer free, three-year survival was at 84% [CI 68.1% -93.7%], while cancer-specific three-year survival rate was at 72%[CI 54.3% -87.2%]. With majority of survivors, 57% (8/14) were maintained normal renal functions. SummaryDespite the fact that radical cystectomy which undoubtedly provide significant improvement in cancer free survival in high-risk MIBC, the present study emphasized relatively inferior outcomes in the developing world due to the delayed presentation.Fifty-three point eight percent (14/26), pT3 or pT4a tumours which is associated with poor cancer specific survival and partly due to the nativity of the caregivers in offering early radical surgery with acceptable complication rates. It was also evident from this study that not only tobacco smocking seems to be the most prevalent risk factor but also associated with significantly poor long term survival

show abstract

“… 12 , 13 In a recent epidemiologic study, we have detected an exceedingly high mortality rate in São Paulo's public hospitals. 11 , 14 There are several public hospitals in this region, and RC was previously performed indistinctively. After noticing this alarming mortality, a centralization program was initiated.…”

Section: Introductionmentioning

confidence: 99%

Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project

Korkes

Timóteo

Martins

et al. 2021

JCO Global Oncology

Self Cite

View full text Add to dashboard Cite

PURPOSE Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 ( P < .002). One-year mortality was also lower in group 2. CONCLUSION Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.

show abstract

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

Cited by 5 publications

References 25 publications

The CABEM Initiative: Saving Patients With Muscle-invasive Bladder Cancer

The CABEM Initiative: Saving Patients With Muscle-invasive Bladder Cancer

Prospective analysis of a radical cystectomy series at a tertiary care center in Sri Lanka –is there room to improve the outcome?

Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project

Contact Info

Product

Resources

About