Radical Cystectomy for Urothelial Carcinoma of the Bladder Without Neoadjuvant or Adjuvant Therapy: Long-Term Results in 1100 Patients

Hautmann, Richard E.; Petriconi, Robert C. de; Pfeiffer, Christina; Volkmer, Bjoern G.

doi:10.1016/j.eururo.2012.02.028

Cited by 355 publications

(226 citation statements)

References 28 publications

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“…Estimated 2-yr DFS (67% vs 58%), CSS (75% vs 63%), and OS (68% vs 63%) after RARC and ORC were similar for the two techniques, respectively [82]. respectively [99]. For this systematic review, 5-yr estimates for DFS, CSS, and OS were 63-74%, 66-80%, and 39-66%, respectively.…”

Section: Potency Recovery After Robot-assisted Radical Cystectomymentioning

confidence: 82%

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

et al. 2015

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Context: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed.Objective: To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC.Evidence acquisition: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted.Evidence synthesis: The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-31% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC.Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-22% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 53-74%, 68-83%, and 72-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Conclusions

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Section: Potency Recovery After Robot-assisted Radical Cystectomymentioning

confidence: 82%

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

et al. 2015

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“…[3][4][5][6] Additionally, perioperative mortality rates rise in octogenarians, 5 and while overall Grade 3-5 complications are similar, one study identified a significant increase in cardiovascular (9.5-19.7%) and neurological (3.9-10.3%) complications. 5 In our study, there were nine Grade 3-5 acute toxicities (22.5%), with one patient who died from sepsis while on treatment (2.5%) and one who suffered a non-fatal myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

“…2 The gold standard therapy for muscleinvasive UC is radical cystectomy; however, cystectomy bears a Grade 3-5 complication rate of 13% 3 and a perioperative mortality of 2.5-5.2%. [3][4][5][6] Additionally, perioperative mortality increases with age, increasing from 4.7% in patients in their 60s, to 6.8-11.1% in octogenarians. 5,7 Even with the additional risks of surgery, population-based evidence suggests local therapy delivered with curative intent improves overall survival (OS) and cancer-specific survival (CSS) in octogenarians.…”

Section: Introductionmentioning

confidence: 99%

Chemoradiotherapy in octogenarians as primary treatment for muscle-invasive bladder cancer

McPherson

Rodrigues

Winquist

et al. 2017

CUAJ

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Introduction: While radical cystectomy is the gold standard for muscle-invasive bladder cancer (MIBC), in octogenarians cystectomy results in a higher perioperative mortality rate (6.8-11.1%) than in younger patients (2.2%). Trimodality therapy is a bladdersparing regimen composed of transurethral resection of bladder tumour (TURBT) and chemoradiotherapy, with intent for salvage cystectomy, and has a 62.5-90% initial complete response rate. In this study, we evaluate TURBT and chemoradiotherapy without salvage cystectomy in medically inoperable octogenarian patients. Methods: We identified a retrospective cohort of patients aged 80-89 years with invasive urothelial carcinoma who received combination chemoradiotherapy between 2008 and June 2014. Outcomes were evaluated by Kaplan-Meier (KM) and Cox regression. Results: In 40 patients, the mean age was 84.5 years (interquartile range [IQR] 83-86). Seventeen patients received hypofractionated, low-dose radiotherapy (LD) (37.5-40 Gy), while 23 received conventionally fractionated radiotherapy (high-dose [HD]) (50-65 Gy). Mean overall survival (OS) was 20.7 months (IQR 12.75-23.25), while mean recurrence-free survival (RFS) was 13.75 months ). Patients receiving HD radiotherapy showed improved OS and local RFS (LRFS) without significant differences in Grade 3-4 toxicities. Univariate Cox regression identified hydronephrosis as a predictor of worse OS and local recurrence and HD radiotherapy as a predictor of improved OS and local recurrence rates. Multivariate Cox regression identified hydronephrosis to be a significant predictor of LRFS. Conclusions: Primary chemoradiotherapy for inoperable patients with MIBC resulted in a three-year OS of 54.9% (comparable to cystectomy) and three-year RFS of 42.3%. Superior outcomes were associated with more aggressive chemoradiotherapy treatment. The results of the local control subanalyses in this study are hypothesisgenerating due to the limited patient numbers in the cohort.

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“…Ayrıca cerrahi öncesi kemoterapi alan olgularda daha çok pT0, daha az cerrahi sınır pozitifliği ve daha çok negatif lenf nodu elde edilmiştir. Bunun yanı sıra pT2 hastalarda neoadjuvan kemoterapinin %90 oranında gereksiz olduğunu bildiren çalışmalar da mevcuttur (15).…”

Section: Neoadjuvan Ve Adjuvan Kemoterapiunclassified

Radical Cystectomy and Organ Preservation Treatment Modalities in Muscle-invasive Bladder Cancer

Kadıhasanoğlu¹,

Aydın²,

Karabay³

et al. 2016

Istanbul Med J

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GirişBatı dünyasında erkeklerde en sık görülen kanserler arasında prostat, akciğer ve kolon kanserinden sonra dördüncü sırada mesane kanseri yer almaktadır (1). Tüm dünya için ciddi bir sağlık problemi oluşturan mesane kanserinde hastaların büyük çoğunluğuna yüzeysel evredeyken tanı konulmakla beraber %20−40 kadarı kasa invaze ya da o evreye ilerlemek üzere tespit edilmektedir ve her yıl 100.000'den fazla olguya kasa invaze ya da ileri evre hastalık tanısı konmaktadır (1). Daha çok erkeklerde görülen mesane kanserinin insidansı kadınlarda da gittikçe artmaktadır.Makroskopik hematüri, işeme bozuklukları ve pelvik ağrı gibi belirtilerle ortaya çıkan mesane kanserinde tanı, transüretral yoldan kas tabakasını da içerecek şekilde yapılan rezeksiyondan elde edilen doku örneklerinin patolojik değerlendirmesi sonucu konulur. Tedavideki amaç, hastaya tümörsüz ve konforlu bir yaşam sağlamaktır. Bu amaçla günümüzde çift taraflı pelvik lenfadenektomi ile beraber uygulanan radikal sistektomi (RS) altın standart tedavi yöntemi olarak kabul edilse de seçilmiş hastalara mesane koruyucu yaklaşımlar birçok merkezde uygulanmaktadır.Bu derlemede amaç, güncel literatür eşliğinde mesane kanseri tedavisinde uygulanan yöntem-leri gözden geçirerek radikal cerrahi yöntemle mesane koruyucu girişimlerin değerlendirmesini yapmaktır. Radikal Sistektomi GirişRadikal sistektomi ve çift taraflı pelvik lenfadenektomi, günümüzde kasa invaze mesane kanserlerinin tedavisinde altın standart olarak kabul edilmektedir. RS geleneksel olarak lokalize (cT2N0M0) ve lokal ileri evre (cT3a-T4a, N0-NX, M0) mesane kanserinde önerilen tedavi seçeneğidir (2). Bunun dışında yüksek riskli ve tekrarlayan yüzeyel tümörlerde, BCG'ye dirençli karsinoma insituda (cis), yük-sek dereceli T1 tümörlerde ve transüretral rezeksiyon ve intravezikal tedaviyle kontrol edilemeyecek yaygın papiller tümörlerde de RS endikasyonu bulunmaktadır (3). Uzun dönem hastalıksız sağ kalım oranı %70'in üzerinde bildirilmekte olan RS, en başarılı sağ kalım ve an az lokal rekürrens oranlarına da sahip olup tümörün tam olarak ortadan kaldırılmasını sağlar. Organ korucu yöntemlerin tümörü tamamen temizleyememeleri ve zaman kaybına neden olmaları dolayısıyla RS'nin başarısını düşürdüğü bilinmektedir. Tanı konulduktan sonra radikal operasyon için 90 günden fazla bekletilen hastalarda ekstravezikal hastalık riski %2'den %81'e çıkmaktadır (4). Kasa İnvaze Mesane Tümörlerinde Radikal Sistektomi ve Organ Koruyucu Tedavi Seçenekleri Radical Cystectomy and Organ Preservation Treatment Modalities in Muscleinvasive Bladder CancerWorldwide, bladder carcinoma is the most diagnosed cancer, and it is the most common urologic malignancy among men in Turkey. Although bladder carcinoma is diagnosed at an early stage of the disease, 100,000 patients are diagnosed with the muscle-invasive or advanced stage each year. Radical cystectomy (RC) and bilateral lymph node dissection are the gold standard treatments for muscle-invasive bladder cancer. Partial cystectomy, chemotherapy, radiotherapy, transurethral resectio...

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Radical Cystectomy for Urothelial Carcinoma of the Bladder Without Neoadjuvant or Adjuvant Therapy: Long-Term Results in 1100 Patients

Cited by 355 publications

References 28 publications

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

Chemoradiotherapy in octogenarians as primary treatment for muscle-invasive bladder cancer

Radical Cystectomy and Organ Preservation Treatment Modalities in Muscle-invasive Bladder Cancer

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