Differential Complication Rates Following Radical Cystectomy in the Irradiated and Nonirradiated Pelvis

Ramani, Vijay; Maddineni, Satish B; Grey, Benjamin R.; Clarke, Noel W.

doi:10.1016/j.eururo.2009.12.002

Cited by 53 publications

(25 citation statements)

References 29 publications

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“…[60][61][62][63][64][65] Reportedly, intermediatedose (45-55 Gy) pelvic irradiation does not significantly increase mortality, but does increase morbidity associated with stomal stenosis. 57 As for low-dose pelvic irradiation, induction CRT at 40 Gy does not severely compromise subsequent RC. Of 87 patients who underwent RC after induction CRT, none experienced perioperative grade 4 (lifethreatening complications) or grade 5 (death) complications according to the Clavien-Dindo classification.…”

Section: Increased Mortality and Morbidity Of Salvage Rcmentioning

confidence: 99%

“…Pelvic irradiation causes tissue vulnerability, desmoplastic reaction and ischemia that can affect the surrounding pelvic structures including ureters, the urethra, small bowel and rectum, 56,57 making subsequent RC and urinary diversion more technically demanding and morbid. The risk of complications depends on the doses of radiation given.…”

Section: Increased Mortality and Morbidity Of Salvage Rcmentioning

confidence: 99%

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Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Koga

Kihara

2012

Int J of Urology

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Abbreviations & Acronyms BIS = bladder-intact survival CIS = carcinoma in situ CR = complete response CRT = chemoradiotherapy CSS = cancer-specific survival FU = fluorouracil GasLESS = gasless laparoendoscopic single-port surgery GC = gemcitabine, cisplatin HD = hemodialysis IAC = intra-arterial chemotherapy IMRT = intensity-modulated radiation therapy LCRT = low-dose chemoradiotherapy MCV = methotrexate, cisplatin and vinblastine MIBC = muscle-invasive bladder cancer MRI = magnetic resonance imaging MVAC = methotrexate, vinblastine, adriamycin and cisplatin NA = not available NFkB = nuclear factor kB NMIBC = non-muscle-invasive bladder cancer OS = overall survival PC = partial cystectomy PLND = pelvic lymph node dissection QoL = quality of life RC = radical cystectomy RTOC = Radiation Therapy Oncology Group SPARE = Selective bladder Preservation Against Radical Excision TMDU = Tokyo Medical and Dental University TURBT = transurethral resection of bladder tumors Abstract: Radical cystectomy plus urinary diversion, the reference standard treatment for muscle-invasive bladder cancer, associates with high complication rates and compromises quality of life as a result of long-term effects on urinary, gastrointestinal and sexual function, and changes in body image. As a society ages, the number of elderly patients unfit for radical cystectomy as a result of comorbidity will increase, and thus the demand for bladder-sparing approaches for muscle-invasive bladder cancer will also inevitably increase. Trimodality bladder-sparing approaches consisting of transurethral resection, chemotherapy and radiotherapy (S55-65 Gy) yield overall survival rates comparable with those of radical cystectomy series (50-70% at 5 years), while preserving the native bladder in 40-60% of muscle-invasive bladder cancer patients, contributing to an improvement in quality of life for such patients. Limitations of the trimodality therapy include (i) muscle-invasive bladder cancer recurrence in the preserved bladder, which most often arises in the original muscle-invasive bladder cancer site; (ii) potential lack of curative intervention for regional lymph nodes; and (iii) increased morbidity in the event of salvage radical cystectomy for remaining or recurrent disease as a result of high-dose pelvic irradiation. Consolidative partial cystectomy with pelvic lymph node dissection followed by induction chemoradiotherapy at lower dose (e.g. 40 Gy) is a rational strategy for overcoming such limitations by strengthening locoregional control and reducing radiation dosage. Molecular profiling of the tumor and functional imaging might play important roles in optimal patient selection for bladder preservation. Refinement of radiation techniques, intensified concurrent or adjuvant chemotherapy, and novel sensitizers, including molecular targeting agent, are also expected to improve outcomes and consequently provide more muscle-invasive bladder cancer patients with favorable quality of life.

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Section: Increased Mortality and Morbidity Of Salvage Rcmentioning

confidence: 99%

Section: Increased Mortality and Morbidity Of Salvage Rcmentioning

confidence: 99%

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Koga

Kihara

2012

Int J of Urology

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“…1 More recent series from high volume centres have reported low complication rates and no difference in perioperative mortality in primary or salvage cystectomy. 2 To our knowledge, there has only been one other report on an incarcerated hernia causing mechanical obstruction to an ileal conduit. 3 The surgical maxim of pain and increased tenderness over an irreducible hernia indicates obstruction and impending ischaemia.…”

Section: Discussionmentioning

confidence: 99%

Obstruction of an ileal urinary conduit in an incarcerated right inguinal hernia

Young¹,

Weston²

2015

annals

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We present the case of a 72-year-old man with a history of anuria from his ileal conduit 15 months following its formation. That conduit had become incarcerated in a right-sided ingunial hernia. The patient presented with anuria and an acute kidney injury. A clincal diagnosis of an incarcerated hernia was made, and he was taken to theatre for reduction and repair of the hernia. On removal of the conduit from the hernial sac, it began to drain immediately. He made a full recovery, with normalisation of his renal function. KEYWORDSIleal conduit -Obstruction -Inguinal hernia Case HistoryA 72-year-old man presented acutely to the urology team with a 12-hour history of anuria from his ileal conduit. He had undergone a radical cystourethrectomy with ileal conduit formation 15 months previously for a pT2 N0 Mx G3 transitional cell carcinoma of the bladder. A coincidental adenocarcinoma of the prostate (Gleason score 6) was identified in the specimen.The patient was known to have longstanding bilateral inguinal hernias. The intention was for a synchronous herniorrhaphy to be performed at the time of radical pelvic surgery. For some reason, this never occurred. On admission, examination confirmed an irreducible right inguinal hernia, which was locally tender. There was also a reducible left inguinal hernia on the contralateral side. There were no signs of obstruction.Initial blood tests revealed a white cell count of 18.5 Â 10 9 /l, a creatinine of 370mol/l and a urea of 17mg/dl. Six hours following admission, the patient reported increasing pain in relation to his hernia. A repeat urea, electrolytes and creatinine test revealed his creatinine had increased to 448mol/l and his urea was now 22mg/dl. A clinical diagnosis of an incarcerated inguinal hernia containing the ileal conduit was made and he was taken urgently to theatre without imaging.At operation, the ileal conduit was found to be incarcerated in the hernial sac. It was oedematous and distended but viable. As soon as the conduit was removed from the hernial sac, it began to drain good volumes of urine. The hernial sac was opened and in view of the incarceration, the hernia was repaired with Prolene ® (Ethicon, Somerville, NJ, US) sutures rather than mesh. The patient made an uncomplicated recovery with normalisation of his renal function on discharge. DiscussionHistorical series have quoted high complication rates following radical cystectomy for bladder cancer.1 More recent series from high volume centres have reported low complication rates and no difference in perioperative mortality in primary or salvage cystectomy.2 To our knowledge, there has only been one other report on an incarcerated hernia causing mechanical obstruction to an ileal conduit. 3 The surgical maxim of pain and increased tenderness over an irreducible hernia indicates obstruction and impending ischaemia. In our case, there was also anuria, leading to a clinical diagnosis of an obstructed ileal conduit, which was confirmed at surgery. There was no obvious reason why the diversion h...

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“…However, study results from a 30-year period indicate that the postoperative 5-year survival rate of radical cystectomy is only 40-60% (4). In addition, due to the high perioperative mortality rate (1.5-4.2%) and incidence of complications (67%) (5,6), which seriously affect the quality of life following urinary diversion and damage the sexual function of male patients after surgery, the 'gold standard' status for radical cystectomy has been challenged.…”

Section: Introductionmentioning

confidence: 99%

“…Residual tumor and pathological downstaging following TURBt is not uncommon (11). For patients with invasive bladder cancer, TURBT alone can at most only reduce tumor burden, and alleviate symptoms such as frequent urination, urgency with urination and bloody urine; and ~50% of patients have distant metastases postoperatively (6). By contrast, partial cystectomy enables complete resection of the full thickness of the lesion and ensures adequate safety margins, with a low incidence of residual tumor.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the short-term efficacy of sequential treatment with intravesical single-port laparoscopic partial cystectomy with bladder preservation or open partial cystectomy in combination with cisplatin plus gemcitabine chemotherapy

Mai

Liu

Pei

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. This study aimed to assess the short-term efficacy of sequential therapy for T2/T3a bladder cancer with intravesical single-port laparoscopic partial cystectomy or open partial cystectomy combined with cisplatin plus gemcitabine (GC) chemotherapy in a prospective randomized controlled study. Thirty patients with bladder cancer who underwent open partial cystectomy (group A) or single-port laparoscopic partial cystectomy (group B) and received standard GC chemotherapy were analyzed. Perioperative functional indicators and tumor recurrence during a 1-year postoperative follow-up were compared between the two groups. The baseline characteristics were comparable between the two groups. The mean operative time, amount of blood loss and duration of hospital stay were 90.3 min, 182.0 ml and 7.3 days, respectively, for group A, and 105.3 min, 49.3 ml and 5.8 days, respectively, for group B. No secondary postoperative bleeding, urine leakage, wound infection or other complications were observed in the two groups. Postoperative scarring was not evident in group B. The overall incidence of surgical complications, tumor recurrence rate and complications during chemotherapy in the postoperative follow-up period of 12 months were similar between the two groups. Single-port laparoscopic partial cystectomy surgery is an idea surgical method for the treatment of invasive bladder cancer, with good surgical effect, minimal invasiveness, rapid recovery and short hospital stay. The data from 1-year postoperative follow-up showed that laparoscopic surgery was superior with regard to perioperative bleeding, postoperative recovery and duration of indwelling urinary catheter use. However, regarding the tumor recurrence rate, long-term comparative details are required to determine the effect of laparoscopic surgery. IntroductionAs a surgical method to preserve the bladder, partial cystectomy can be used to achieve full-thickness resection of the bladder wall and complete resection of bladder lesions, in addition to ensuring adequate margins. In the 1950s, partial cystectomy became widely used to treat muscle-invasive bladder cancer (MIBC); however, due to its high recurrence rate (40-78%), together with the development of controllable urinary diversion technology and the application of total cystectomy with preservation of nerves and prostate, radical cystectomy has become the 'gold standard' for the treatment of MIBC (1-3). However, study results from a 30-year period indicate that the postoperative 5-year survival rate of radical cystectomy is only 40-60% (4). In addition, due to the high perioperative mortality rate (1.5-4.2%) and incidence of complications (67%) (5,6), which seriously affect the quality of life following urinary diversion and damage the sexual function of male patients after surgery, the 'gold standard' status for radical cystectomy has been challenged.A study (7) has shown that ~50% of MIBC has dominant or occult local or distant metastasis at the first diagnosis. For these patients whose prognoses cannot ...

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Differential Complication Rates Following Radical Cystectomy in the Irradiated and Nonirradiated Pelvis

Cited by 53 publications

References 29 publications

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Obstruction of an ileal urinary conduit in an incarcerated right inguinal hernia

Comparison of the short-term efficacy of sequential treatment with intravesical single-port laparoscopic partial cystectomy with bladder preservation or open partial cystectomy in combination with cisplatin plus gemcitabine chemotherapy

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