Factors influencing intraoperative conversion from planned orthotopic to non-orthotopic urinary diversion during radical cystectomy

Ghodoussipour, Saum; Ahmadi, Nariman; Hartman, Natalie; Cacciamani, Giovanni; Miranda, Gus; Cai, Jie; Schuckman, Anne; Djaladat, Hooman; Gill, Inderbir S.; Daneshmand, Siamak; Desai, Mihir

doi:10.1007/s00345-018-2582-2

Cited by 7 publications

(2 citation statements)

References 13 publications

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“…[5][6][7][8][9] In addition, a positive urethral margin in intraoperative FSA is the main reason for conversion to incontinent urinary diversion during RC. 28 However, in our study, there was no statistically significant difference in the UR rate based on urethral margin status (P = 0.22). Furthermore, a clinical dilemma is that there is a discrepancy between intraoperative FSA and the final pathology in the urethra.…”

Section: Discussioncontrasting

confidence: 69%

<p>Risk Factors for Urethral Recurrence in Men After Radical Cystectomy with Orthotopic Urinary Diversion for Urothelial Carcinoma: A Retrospective Cohort Study</p>

Lee

Song

2020

CMAR

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Purpose: To evaluate the risk factors affecting urethral recurrence (UR) in men after radical cystectomy (RC) with ileal orthotopic neobladder (IONB). Materials and Methods: We retrospectively reviewed 348 men who underwent RC with IONB for bladder cancer between January 2010 and December 2017. Clinicopathologic characteristics, including tumor location (trigone and/or bladder neck), prostatic urethral and/or stromal involvement, presence of carcinoma in situ (CIS), pathologic T and N stage, and urethral resection margin status, were identified. Kaplan-Meier survival analysis was used to illustrate urethral recurrence-free survival (URFS), and Cox proportional hazard models were applied to identify factors predicting UR. Results: Of the 348 patients, UR was identified in 7 (2.0%) patients during the mean followup of 33.3 months. The 2-, 3-, and 5-year URFS rates were 97.6%, 96.3%, and 93.8%, respectively. On multivariable analysis, prostatic urethral involvement (P = 0.033, hazard ratio: 6.25, 95% confidence interval: 1.06-36.96) was an independent predictor of UR. When patients were divided according to prostatic urethral involvement (negative vs positive), the 2-and 3-year URFS rates were significantly different (93.8% and 96.8%, respectively, vs 92.0% and 92.0%, respectively; P = 0.020). All 7 patients with UR underwent transurethral surgery and maintained their IONB. Conclusion: In this series, UR occurred in approximately 2% of men after RC with IONB. Prostatic urethral involvement was the only significant prognostic factor for UR. Follow-up strategies considering UR risk should be adopted to facilitate early detection in those at high risk of UR.

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Section: Discussioncontrasting

confidence: 69%

<p>Risk Factors for Urethral Recurrence in Men After Radical Cystectomy with Orthotopic Urinary Diversion for Urothelial Carcinoma: A Retrospective Cohort Study</p>

Lee

Song

2020

CMAR

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“…The main limitation of this study is that HDRs contain no cancer-specific data, such as histology, stage, or grade, nor the number of lymph nodes yielded by the RC. Histology and cancer stage have been found to be predictors of postsurgical mortality [26], but grade and stage of disease had a debatable impact on variations in diversions after RC [5,27,28]. Moreover, there was no possibility of record linkage to cancer registry data and outpatient treatments archives; consequently, data on the time interval between diagnosis and RC, or prior or adjuvant treatments, such as local therapy or radiotherapy, were not available.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients

Fedeli¹,

Paoli²,

Corti³

et al. 2020

Urol Int

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Population-based data on survival after radical cystectomy (RC) are lacking from Southern Europe. The aim of this study was to assess trends and determinants of perioperative mortality and long-term survival in the Veneto region (Northeastern Italy). Methods: All patients submitted to RC for bladder cancer from January 2004 to December 2016 were identified from the regional archive of hospital discharge records. Age at surgery, gender, comorbidities, hospital volume, calendar period of surgery, and type of urinary diversion were retrieved; vital status and cause of death were obtained by linkage with mortality records. Determinants of 90-day mortality were assessed by multilevel logistic regression; long-term survival was investigated by the Kaplan-Mei-er method and Cox regression. Results: Among 4,389 included patients, an increase in the share of patients aged ≥80 years (from 13% in 2004-2008 to 24% in 2013-2016, p < 0.001) and a decline in performing continent diversion (from 34.9 to 23.4%, p < 0.001) were observed across the study period. Ninety-day mortality did not change over time and was 4% for patients aged < 70 years and 13.7% for those aged ≥80 years. Age-and comorbidities-adjusted mortality was significantly lower in hospitals performing > 30 RCs/year (odds ratio 0.67, 95% confidence interval 0.48-0.93). At a median follow-up of 67 months, overall survival at 1 year and 5 years was 72 and 40%, respectively, with a higher rate among younger patients treated in high-volume hospitals. Conclusion: The population of patients treated with RC is rapidly ageing, with a high risk of perioperative and long-term mortality; this changing epidemiological scenario and better outcomes observed in high-volume hospitals support regionalization of the procedure.

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MIBC: A Systematic Review on Orthotopic Neobladder vs. Ileal Conduit, Which Is Better?

Goonewardene

Ventii

Bahl

et al. 2021

Management of Urology

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Factors influencing intraoperative conversion from planned orthotopic to non-orthotopic urinary diversion during radical cystectomy

Cited by 7 publications

References 13 publications

<p>Risk Factors for Urethral Recurrence in Men After Radical Cystectomy with Orthotopic Urinary Diversion for Urothelial Carcinoma: A Retrospective Cohort Study</p>

<p>Risk Factors for Urethral Recurrence in Men After Radical Cystectomy with Orthotopic Urinary Diversion for Urothelial Carcinoma: A Retrospective Cohort Study</p>

Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients

MIBC: A Systematic Review on Orthotopic Neobladder vs. Ileal Conduit, Which Is Better?

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