Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer

Maisch, Phillipp; Lunger, Lukas; Düwel, Charlotte; Schmid, Sebastian; Horn, Thomas; Gschwend, Jürgen E.; Sauter, Andreas; Heck, Matthias

doi:10.1016/j.urolonc.2020.11.042

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…The preoperative diagnostics therefore are of highest interest for the surgeon and the preparation of the operation. Maisch et al (19) have shown that cystectomies in locally advanced pT4 bladder cancer is associated with an increased 90-day mortality rate; moreover, these findings go in line with the data of Isbarn et al (20) who showed that not only age, but also tumor stage and histological subtype represent independent risk factors of perioperative mortality in bladder cancer. With this background, our data fit well in the existing context of current literature.…”

Section: Discussionsupporting

confidence: 75%

Comparative Analysis of Elderly Patients Undergoing Radical Cystectomy With Ureterocutaneostomy or Ileal Conduit With a Special Focus on Bowl Complications Requiring Surgical Revision

et al. 2022

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ObjectivesIleal conduits (ICs) carry an additional perioperative complication risk due to the bowel procedure. This analysis compares surgical outcomes in patients ≥75 years of age with ureterocutaneostomy (UCN) and IC after cystectomy (Cx).MethodsData of 527 patients included in a retrospective cystectomy database of two high volume centers (2008–2020) were queried to identify elderly patients (≥75 years) who underwent Cx either with IC or UCN. Patient characteristics of all patients [age, BMI, Charlson Comorbidity Index (CCI)], perioperative parameters (operation time, blood loss, transfusions, tumor stage), and postoperative complications (clavien >IIIA, intensive care unit (ICU) stay) were compared. As special focus, bowel complications requiring surgical revision (rBCs) were analyzed. In patients with IC, the rate of ureteral implantation stenosis (USt) was recorded. As a population of special interest, patients ≥80 years of age were analyzed separately. Categorical data were compared using Fisher exact test, and continuous data were compared using Mann–Whitney U test.ResultsA total of 163 patients ≥75 years of age (125 IC, 38 UCN) were identified. Patients with UCN were older and presented with a higher CCI, though differences were not statistically different. Surgery with palliative intent was more frequent in patients with UCN (37 vs. 10%). Operation time in UCN was significantly shorter (233 vs. 305 min, p = 0.02), while blood loss and transfusion rate were comparable. Overall complication rate (Clavien-Dindo grade IIIA–IVB) was comparable (UCN 34% vs. IC 37%). However, rBC was a rare complication in UCN (3/38) as compared to patients with IC (15/125). Frequency of postoperative ICU stay (UCN 16% vs. IC 16%) and 90-day mortality did not differ (UCN 3/38 patients, IC 5/125 patients). Regarding long-term follow-up, USt requiring revision or permanent stenting was seen in 18/125 (14%) patients with IC. In patients >80 years of age, results were comparable to the main cohort. Low event rate regarding complications and bias inherent of a retrospective analysis (selection bias, unequal distribution in case numbers) precludes detection of statistical differences regarding patients' characteristics and overall complication rate.ConclusionUCN is an alternative to IC in elderly and/or frail patients. Severe bowel complications are numerically less frequent and operation time is minimized.

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Section: Discussionsupporting

confidence: 75%

Comparative Analysis of Elderly Patients Undergoing Radical Cystectomy With Ureterocutaneostomy or Ileal Conduit With a Special Focus on Bowl Complications Requiring Surgical Revision

et al. 2022

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“…In a large SEER database study by Liberman et al ( 2 ), patients with pT4b that underwent Cx had a significantly higher CSM rate than patients with pT4a (2.1-fold) or pT3 (2.3-fold). In our study, the median OS for all patients was 21.0 months, which is longer than the previously published studies indicating 13 months ( 5 ). Our findings are partially consistent with the above conclusion, where pT4b was a predictor of poor survival; however, we failed to verify the role of the features associated with metastatic tumor dissemination.…”

Section: Discussioncontrasting

confidence: 74%

“…The benefit and safety of Cx in patients with locally advanced pT4 stage BCa have been investigated in several studies ( 2 , 5 – 9 ). Nagele et al ( 8 ) analyzed 20 patients with pT4 BCa subjected to primary Cx, with only two patients experiencing severe complications; after a 20-month follow-up, 55% ( n = 11) of patients were still alive, thus supporting the rationale of primary Cx for pT4 BCa as a feasible approach with tolerable complications.…”

Section: Discussionmentioning

confidence: 99%

Survival prediction among pathologic T4 bladder cancer patients following cytoreductive cystectomy: A retrospective single-center study

Bai

Chen²,

Shang³

et al. 2023

Front. Surg.

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ObjectivesThis retrospective study aimed to describe our institutional experience with cytoreductive cystectomy (Cx) in patients with pathological T4 (pT4) bladder cancer (BCa) and to investigate the clinicopathologic factors that can predict patient survival outcomes.MethodsWe reviewed the baseline demographics, clinicopathologic features, perioperative complications, and follow-up data of 44 patients who underwent Cx for pT4 BCa at our institution between 2013 and 2021. The Kaplan–Meier curve and the log-rank test were used to analyze progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analyses were performed using the Cox regression model.ResultsThe median age of the patients was 68 years [95% confidence interval (CI) 49–81]. Overall, 21 patients (47.7%) were estimated to have a high age-adjusted Charlson comorbidity index (ACCI) score (>4), and nine patients (20.5%) had pT4b substage BCa. None of the patients died of complications within 30–90 days after surgery. Severe complications occurred in 16% (n = 7) of patients within 30–90 days. During a median follow-up of 51 months, disease progression was detected in 25 patients (56.8%), and 29 patients (65.9%) died of any cause. The median PFS and OS were 15.0 and 21.0 months, respectively. The Kaplan–Meier analysis indicated that patients with high ACCI scores or pT4b BCa had worse PFS (P = 0.003 and P = 0.002, respectively) and OS (P = 0.016 and P = 0.034, respectively) than those with low ACCI scores or pT4a BCa. On multivariate analysis, pT4b substage [hazard ratio (HR), 4.166; 95% CI, 1.549–11.206; P = 0.005] and ACCI score >4 (HR, 2.329; 95% CI, 1.105–4.908; P = 0.026) remained independent risk factors for PFS and OS, respectively.ConclusionOur study revealed that the pT4b substage is associated with a poor prognosis and that the ACCI score is a relevant and practical method to evaluate survival outcomes in patients with pT4 BCa after Cx.

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“…Approximately 25% of newly diagnosed patients with bladder cancer presented as muscle invasive disease (1), and 2% as locally advanced (pT4) (20), with high probability of manifesting irritative lower urinary tract symptoms (LUTS), suprapubic pain and gross hematuria. Therefore, advanced bladder cancer can be significantly disabling and can worsen patients' quality of life.…”

Section: Discussion and Conclusion Remarksmentioning

confidence: 99%

Extraperitoneal cystectomy with ureterocutaneostomy derivation in fragile patients - should it be performed more often?

Malinaric

Mantica

Balzarini

et al. 2022

Arch Ital Urol Androl

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Introduction and objectives: Radical cystectomy (RC) continues to be standard of care for muscle-invasive bladder cancer and recurrent or refractory nonmuscle invasive bladder cancer. Unfortunately, it has high rates of perioperative morbidity and mortality. One of the most important predictors of postoperative outcomes is frailty, while the majority of complications are diversion related. The aim of our study was to evaluate safety of extraperitoneal cystectomy with ureterocutaneostomy in patients considered as frail. Materials and methods: We retrospectively collected data of frail patients who underwent extraperitoneal cystectomy with ureterocutaneostomy from October 2018 to August 2020 in a single center. We evaluated frailty by assessing patients' age, body mass index (BMI), nutritional status by Malnutrition Universal Screening Tool, overall health by RAI (Risk Analysis Index) and ASA (American Society of Anaesthesiologists) score, and laboratory analyses. We observed intraoperative outcomes and rates of perioperative (within 30 days) and early postoperative (within 90 days) complications (Clavien-Dindo classification). We defined extraperitoneal cystectomy with ureterocutaneostomy as safe if patients did not develop Clavien Dindo IIIb, or worse, complication. Results: A total of 34 patients, 3 female and 31 male, were analyzed. The median age was 77, BMI 26, RAI 28, ASA 3 and the majority had preexisting renal insufficiency. Blood analyses revealed presence of severe preoperative hypoalbuminemia and anemia in half of our cohort. Intraoperative median blood loss was 250 cc, whilst operative time 245 min. During perioperative period 60% of our cohort developed Clavien Dindo II complication and during early postoperative period 32% of patients required readmission. One death occurred during early postoperative period (2.9%). After 12 months of follow-up, we observed stability of the renal function for most patients. Conclusions: We believe that extraperitoneal cystectomy with ureterocutaneostomy could be considered as a treatment option for elderly and/or frail patients.

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Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer

Cited by 11 publications

References 24 publications

Comparative Analysis of Elderly Patients Undergoing Radical Cystectomy With Ureterocutaneostomy or Ileal Conduit With a Special Focus on Bowl Complications Requiring Surgical Revision

Comparative Analysis of Elderly Patients Undergoing Radical Cystectomy With Ureterocutaneostomy or Ileal Conduit With a Special Focus on Bowl Complications Requiring Surgical Revision

Survival prediction among pathologic T4 bladder cancer patients following cytoreductive cystectomy: A retrospective single-center study

Extraperitoneal cystectomy with ureterocutaneostomy derivation in fragile patients - should it be performed more often?

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