Salvage cystectomy and ileal conduit urinary diversion as a last‐line option for benign diseases—perioperative safety and postoperative health‐related quality of life

Abstract

Aims Radical cystectomy and urinary diversion impact various dimensions of patients' health‐related‐quality‐of‐life (HRQOL). Yet, less is known about salvage cystectomy as a last‐line option for treatment‐refractory benign diseases. Therefore, our aim is to provide HRQOL data from a contemporary cohort of open salvage cystectomies for benign conditions. Methods Fifty‐four consecutive patients were enrolled in one single tertiary referral center. Analysis was limited to patients undergoing urinary diversion via ileal conduit (IC). Complications were assessed via Clavien–Dindo‐scale. HRQOL was measured using the validated European Organization for Research and Treatment of Cancer QLQ‐C30 and QLQ‐BLM30 questionnaire. HRQOL QLQ‐C30 domains were measured preoperatively and up to 3 years postoperatively. Longitudinal changes were analyzed using Friedman's rank test. Primary endpoint was good general HRQOL based on QLQ‐C30 global health status (GHS). Multivariate analysis was performed using logistic regression models with a step‐wise backward selection procedure. Results Longitudinal analysis of HRQOL subdomains revealed significantly improved pain (p = .005) and fatigue (p = .002) scores as well as improved social functioning (p = .038). Furthermore, general HRQOL (GHS scores) improved significantly during the follow‐up period (28.0 vs. 50.6 [36 months], p = .045). In multivariate analysis, the indication for salvage cystectomy could not be identified as an independent predictor for good general HRQOL. We observed a total number of 10 (41.7%) high‐grade (Clavien ≥III) 90 day‐complications. Limitations include limited follow‐up rates at respective time‐points. Conclusion Salvage cystectomy and IC can be safely performed as a last‐line treatment for benign conditions and increases general HRQOL in the long‐term follow‐up. Thus, it can play a role in a holistic approach for a challenging clinical setting.

A new stoma for an older person—An association with quality of life and physical function: A systematic review

“…Twenty‐four (96%) of the studies had good selection, and 12 studies (48%) were assessed as having good comparability using the Newcastle‐Ottawa Scale assessment tool (Table S5). Thirteen of the twenty‐five studies (52%) exhibited a study level “good” quality assessment, 21–23,27–30,32,33,37,41–43 eight (32%) “fair” quality, 20,25,31,35,38–40,44 and four (20%) “unclear” quality, 24,26,34,36 and none of the included studies were found to be of “poor” quality.…”

“…Silva found that physical function and quality of life improved in colostomy patients 3–5 months after surgery, and this was maintained at 6–8 months 55 . Volz found that quality of life improved significantly over the 36 months postoperatively; functional scores also improved over this time, but this was not statistically significant 33 …”

“…55 Volz found that quality of life improved significantly over the 36 months postoperatively; functional scores also improved over this time, but this was not statistically significant. 33…”

“…preferred reporting items for systematic reviews and meta-analyses exhibited a study level "good" quality assessment, [21][22][23][27][28][29][30]32,33,37,[41][42][43] eight (32%) "fair" quality, 20,25,31,35,[38][39][40]44 and four (20%) "unclear" quality, 24,26,34,36 and none of the included studies were found to be of "poor" quality.…”

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

“…Since the indication for UD in the benign group is focused primarily on increasing quality of life, it is important to take the risk of complications into account to make well-grounded treatment decisions. Other more recent observational reports have confirmed high complication rates after UD with benign indications for surgery, with 90-day high-grade complication events between 42% and 48% [47,48]. Specifically addressing RARC with UD in patients with severe urinary problems after pelvic irradiation for prostate cancer, a newly published single-centre observational study with no comparison to open surgery, reported a series of 32 patients subjected to incontinent UD [49 & ].…”