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

Fedeli, Ugo; Paoli, Angela De; Corti, Maria Chiara; Cacciamani, Giovanni; Gill, Inderbir S.; Zattoni, Filiberto; Novara, Giacomo; Porreca, Angelo; Artibani, Walter

doi:10.1159/000506240

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…We found age to be a significant factor for discharge to a CFR. However, age is a non-modifiable factor that will likely continue to impact discharge disposition as most patients diagnosed with and undergoing RC for bladder cancer are older [ 32 , 33 , 34 ] with an average age of 73 years at diagnosis [ 35 ]. Care for the post-cystectomy patient can be complex and requires additional support at home [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy

Cacciamani

Lee

Sanford

et al. 2022

Cancers

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Radical cystectomy (RC) is a complex procedure associated with lengthy hospital stays and high complication and readmission rates. We evaluated the impact of patient, surgical, and perioperative factors on discharge disposition following RC at a tertiary referral center. From 2012 to 2019, all bladder cancer patients undergoing RC at our institution were identified (n = 1153). Patients were classified based on discharge disposition: to home or to continued facility-based rehabilitation centers (CFRs, n = 180 (15.61%) patients). On multivariate analysis of patient factors only, age [Risk Ratio (RR): 1.07, p < 0.001)], single marital status (RR: 1.09, p < 0.001), and living alone prior to surgery (RR: 2.55, p = 0.004) were significant predictors of discharge to CFRs. Multivariate analysis of patient, surgical, and perioperative factors indicated age (RR: 1.09, p < 0.001), single marital status (RR: 3.9, p < 0.001), living alone prior to surgery (RR: 2.42, p = 0.01), and major post-operative (Clavien > 3) complications (RR: 3.44, p < 0.001) were significant independent predictors of discharge to CFRs. Of note, ERAS did not significantly impact discharge disposition. Specific patient and perioperative factors significantly impact discharge disposition. Patients who are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to CFRs after RC.

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Section: Discussionmentioning

confidence: 99%

Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy

Cacciamani

Lee

Sanford

et al. 2022

Cancers

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“…While the quality of TURBT has been widely shown to have major impact on prognosis in the setting of NMIBC and of trimodal therapy of MIBC, the influence of a macroscopically complete TURBT before radical cystectomy on oncological outcomes had never been assessed so far. In our series, patients with MIBC or high-risk NMIBC in whom the last TURBT was macroscopically complete as subjectively assessed by the operating surgeon had better pathological and oncological outcomes after radical cystectomy, and improving outcomes is very important in this surgery where perioperative and long-term risk remain very high [11, 12].…”

Section: Discussionmentioning

confidence: 99%

Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes

Graffeille¹,

Verhoest²,

Gryn

et al. 2021

Urol Int

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Objectives: The objective of this study was to assess the impact of complete transurethral resection of bladder tumors (TURBTs) before radical cystectomy on pathological and oncological outcomes of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC. Materials and Methods: The charts of all patients who underwent radical cystectomy for bladder cancer in 2 academic departments of urology between 1996 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the completeness of the last endoscopic resection before radical cystectomy: macroscopically complete transurethral resection (complete) or macroscopically incomplete transurethral resection (incomplete). The primary end point was the recurrence-free survival (RFS). Secondary end points included cancer-specific survival (CSS) and rates of pT0 and downstaging. Results: Out of 486 patients included for analysis, the TURBT immediately preceding radical cystectomy was considered macroscopically complete in 253 patients (52.1%) and incomplete in 233 patients (47.9%). In multivariate analysis, macroscopically complete TURBT was the strongest predictor of both pT0 disease (OR = 3.1; p = 0.02) and downstaging (OR = 7.1; p < 0.0001). After a median follow-up of 41 months, macroscopically complete TURBT was associated with better RFS (5-year RFS: 57 vs. 37%; p < 0.0001) and CSS (5-year CSS: 70.8 vs. 54.5%; p = 0.002). In multivariate analysis adjusting for multifocality, weight of endoscopic resection specimen, cT4 stage on preoperative imaging, interval between endoscopic resection and radical cystectomy, neoadjuvant chemotherapy, pT stage, and associated carcinoma in situ, macroscopically complete endoscopic resection remained the main predictor of better RFS (HR = 0.4; p = 0.0003) and the only preoperative factor associated with CSS (HR = 0.5; p = 0.01). Conclusion: A macroscopically complete TURBT immediately preceding radical cystectomy may improve pathological and oncological outcomes in patients with MIBC and high-risk MIBC.

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“…Studies have mostly found that peri-operative and shortterm outcomes are similar when using robot-assisted versus open radical cystectomy [17][18][19][20], but some data suggests that assisted radical cystectomy improves minor, but not major, complications compared to open surgery [9], especially in terms of lower blood loss and shorter time to returning to a regular diet [17,21,22]. Few data on long-term oncological outcomes are available; initial studies report comparable outcomes for robot-assisted versus open radical cystectomy [19,[22][23][24][25][26][27][28]. Data on the long-term functioning of patients is also sparse, with no studies directly comparing urinary continence or sexual potency in patients receiving robotassisted versus open radical cystectomy [16].…”

Section: Radical Cystectomy: the Gold Standardmentioning

confidence: 99%

Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer

et al. 2021

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Background Bladder cancer is the ninth most common type of cancer worldwide. In the past, radical cystectomy via open surgery has been considered the gold-standard treatment for muscle invasive bladder cancer. However, in recent years there has been a progressive increase in the use of robot-assisted laparoscopic radical cystectomy. The aim of the current project is to investigate the surgical, oncological, and functional outcomes of patients with bladder cancer who undergo radical cystectomy comparing three different surgical techniques (robotic-assisted, laparoscopic, and open surgery). Pre-, peri- and post-operative factors will be examined, and participants will be followed for a period of up to 24 months to identify risks of mortality, oncological outcomes, hospital readmission, sexual performance, and continence. Methods We describe a protocol for an observational, prospective, multicenter, cohort study to assess patients affected by bladder neoplasms undergoing radical cystectomy and urinary diversion. The Italian Radical Cystectomy Registry is an electronic registry to prospectively collect the data of patients undergoing radical cystectomy conducted with any technique (open, laparoscopic, robotic-assisted). Twenty-eight urology departments across Italy will provide data for the study, with the recruitment phase between 1st January 2017-31st October 2020. Information is collected from the patients at the moment of surgical intervention and during follow-up (3, 6, 12, and 24 months after radical cystectomy). Peri-operative variables include surgery time, type of urinary diversion, conversion to open surgery, bleeding, nerve sparing and lymphadenectomy. Follow-up data collection includes histological information (e.g., post-op staging, grading, and tumor histology), short- and long-term outcomes (e.g., mortality, post-op complications, hospital readmission, sexual potency, continence etc). Discussion The current protocol aims to contribute additional data to the field concerning the short- and long-term outcomes of three different radical cystectomy surgical techniques for patients with bladder cancer, including open, laparoscopic, and robot-assisted. This is a comparative-effectiveness trial that takes into account a complex range of factors and decision making by both physicians and patients that affect their choice of surgical technique. Trial registration ClinicalTrials.gov, NCT04228198. Registered 14th January 2020- Retrospectively registered.

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

Cited by 11 publications

References 24 publications

Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy

Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy

Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes

Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer

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