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Luo Q, Xu L, Lin C, Chao H, Zeng T, Zhu Z. The clinical study of urinary flow parameters after drag-and-bond anastomosis for ileal orthotopic neobladder reconstruction. Int Urol Nephrol 2024:10.1007/s11255-024-04015-7. [PMID: 38502467 DOI: 10.1007/s11255-024-04015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
AIM To assess the viability of this procedure in laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction, the objective of this study is to examine the relationship between urinary flow parameters of urethral drag-and-bond anastomosis in the reconstruction of the ileal orthotopic neobladder. METHODS 36 patients with bladder cancer underwent laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction at Jiangxi provincial people's hospital between June 2016 and January 2021,16 patients underwent intermittent urethral anastomosis, while 20 patients underwent neobladder-urethral drag-and-bond anastomosis. The maximum bladder capacity, residual urine output, maximum urinary flow rate, and outlet morphology of the new bladder neck were all monitored throughout postoperative follow-up regularly. RESULTS There was no significant difference between the urethral drag-and-bond anastomosis group (group A) and the conventional anastomosis group (group B) at 3 months and 12 months after surgery, and the maximum bladder capacity (3 months, 488.35 ± 51.56 ml vs 481.06 ± 40.61 ml, t = -0.462, P = 0.647; 12 months, 496.35 ± 51.09 ml vs 476.56 ± 56.33 ml, t = -1.103, P = 0.278), residual urine output (3 months, 44.15 ± 24.12 ml vs 38.69 ± 21.82 ml, t = -0.704, P = 0.486;12 months, 49.65 ± 26.95 ml vs 36.75 ± 21.96 ml, t = -1.546, P = 0.131) and maximum urine flow rate (3 months, 12.36 ± 2.63 ml/s vs 13.60 ± 2.82 ml/s, t = 1.361, P = 0.182;12 months, 12.18 ± 3.14 ml/s vs 11.13 ± 3.01 ml/s, t = -1.004, P = 0.322) of the two groups were not significant (P > 0.05). The new bladder outlet morphology was not distorted in group A patients, the continuity was good, and there were fewer associated complications. CONCLUSIONS There was no significant difference in postoperative urodynamic parameters between the urethral drag-and-bond anastomosis group and the conventional anastomosis group, and the postoperative new bladder outlet was in good shape, with clinical significance.
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Affiliation(s)
- Qixun Luo
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Urology, Jiangxi Provincial People's Hospital, No.92Aiguo Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Lieyu Xu
- Department of Urology, Jiangxi Provincial People's Hospital, No.92Aiguo Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Chuanyun Lin
- Department of Urology, Fenyi County Hospital of Traditional Chinese Medicine, Xinyu, 336600, Jiangxi, China
| | - Haichao Chao
- Department of Urology, Nanchang University Second Affiliated Hospital, Nanchang, 330006, Jiangxi, China
| | - Tao Zeng
- Department of Urology, Nanchang University Second Affiliated Hospital, Nanchang, 330006, Jiangxi, China
| | - Zunwei Zhu
- Department of Urology, Jiangxi Provincial People's Hospital, No.92Aiguo Road, Donghu District, Nanchang, 330006, Jiangxi, China.
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Fu S, Shi H, Fan Z, Li J, Luan T, Dong H, Wang J, Chen S, Zhang J, Wang J, Ding M, Wang H. Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety. Int J Surg 2024; 110:01279778-990000000-00948. [PMID: 38260944 PMCID: PMC11020008 DOI: 10.1097/js9.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. METHODS The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. RESULTS Twenty-two studies involving 7,020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [EBL WMD: -555.52; 95% CI, -681.64 to -429.39; P<0.001], blood transfusion rate [OR: 0.16; 95% CI, 0.09 to 0.28; P<0.001], length of hospital stay [LOS WMD: -2.05; 95% CI, -2.93 to -1.17; P<0.001], Clavien-Dindo grades ≥III complication rate [30d: OR: 0.57; 95% CI 0.44 to 0.75; P<0.001; 90d: OR: 0.71; 95% CI 0.60 to 0.84; P<0.001], and positive surgical margin [PSM OR: 0.65; 95% CI 0.49 to 0.85; P=0.002]. However, iRARC had a longer operative time [OT WMD: 68.54; 95%CI 47.41 to 89.67; P<0.001] and a higher rate of ureteroenteric stricture [ UES OR: 1.56; 95% CI 1.16 to 2.11; P=0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades CONCLUSION Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.
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Affiliation(s)
- Shi Fu
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - HongJin Shi
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhinan Fan
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Urology, Meishan People's Hospital, Meishan, China
| | - Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luan
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haonan Dong
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jincheng Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuwen Chen
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinsong Zhang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiansong Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingxia Ding
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Maisch P, Hwang EC, Kim K, Narayan VM, Bakker C, Kunath F, Dahm P. Immunotherapy for advanced or metastatic urothelial carcinoma. Cochrane Database Syst Rev 2023; 10:CD013774. [PMID: 37811690 PMCID: PMC10561349 DOI: 10.1002/14651858.cd013774.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors are increasingly important in the treatment algorithm for locally advanced and metastatic bladder cancer. Numerous ongoing studies are investigating these agents as first- and second-line therapies, both alone and in combination with chemotherapy or in a maintenance therapy setting. OBJECTIVES To assess the effects of immune checkpoint inhibitors compared to chemotherapy as first- and second-line treatment of advanced or metastatic urothelial carcinoma. SEARCH METHODS We performed a comprehensive search including the Cochrane Library, MEDLINE, Embase, three other databases, several trial registers, other sources of gray literature, and conference proceedings, with no restrictions on language of publication. We limited the search period to run from 2000 until August 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) using immunotherapy versus chemotherapy and would have considered non-randomized trials in the absence of randomized trial data. Participants had locally advanced inoperable (cT4b or N+, or both) or metastatic (M1) (or both) urothelial carcinoma of the bladder or upper urinary tract. We excluded studies of people in whom immunotherapy was used in combination with chemotherapy or in a surveillance setting. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies for inclusion and abstracted data from included studies. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence on a per-outcome basis. MAIN RESULTS We included five RCTs and identified seven single-armed studies. The RCTs included 3572 participants comparing immunotherapy versus chemotherapy for the treatment of locally advanced and metastatic bladder cancer. First-line therapy Immunotherapy probably has little to no effect on the risk of death from any cause when used as first-line therapy compared to chemotherapy (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.87 to 1.07; I2 = 0%; 3 studies, 2068 participants; moderate-certainty evidence). This corresponds to 750 deaths per 1000 participants with chemotherapy and 11 fewer (45 fewer to 26 more) deaths per 1000 participants with immunotherapy at 36 months. Immunotherapy probably has little to no effect on health-related quality of life (mean difference (MD) 4.10, 95% CI 3.83 to 4.37; 1 study, 393 participants; moderate-certainty evidence), when assuming a minimal clinically important difference (MCID) of at least 6 points (using the Functional Assessment of Cancer Therapy - Bladder [FACT-BL] tool; scale 0 to 156 with higher scores representing better quality of life). Immunotherapy probably reduces adverse events grade 3 to 5 (RR 0.47, 95% CI 0.29 to 0.75; I2 = 97%; 3 studies, 2046 participants; moderate-certainty evidence). This corresponds to 908 grade 3 to 5 adverse events per 1000 participants with chemotherapy, with 481 fewer (644 fewer to 227 fewer) grade 3 to 5 adverse events per 1000 participants with immunotherapy. We found no evidence for the outcome time to death from bladder cancer. Immunotherapy probably increases the risk of time to disease progression (HR 1.33, 95% CI 1.17 to 1.50; I2 = 0%; 2 studies, 1349 participants; moderate-certainty evidence). This corresponds to 660 events per 1000 participants with chemotherapy and 102 more (57 more to 152 more) events per 1000 participants with immunotherapy at 36 months. Immunotherapy may reduce discontinuations due to adverse effects (RR 0.47, 95% CI 0.20 to 1.10; I2 = 94%; 3 studies, 2046 participants; low-certainty evidence). This corresponds to 338 discontinuations per 1000 participants with chemotherapy and 179 fewer (271 fewer to 34 more) discontinuations per 1000 participants with immunotherapy. Second-line therapy Immunotherapy may reduce the risk of death from any cause when used as second-line therapy (HR 0.72, 95% CI 0.63 to 0.81; I2 = 0%; 2 studies, 1473 participants; low-certainty evidence). This corresponds to 920 deaths per 1000 participants with chemotherapy (vinflunine, paclitaxel, docetaxel) and 59 fewer (95 fewer to 28 fewer) deaths per 1000 participants with immunotherapy at 36 months. Immunotherapy may have little to no effect on health-related quality of life when compared to chemotherapy (MD 4.82, 95% CI -3.11 to 12.75; I2 = 85%; 2 studies, 727 participants; low-certainty evidence), assuming an MCID of at least 10 points (using the EORTC QLQ tool; scale 0 to 100 with higher scores representing better quality of life). Immunotherapy may reduce adverse events grade 3 to 5 in participants undergoing second-line therapy (RR 0.89, 95% CI 0.81 to 0.97; I2 = 9%; 2 studies, 1423 participants; low-certainty evidence). This corresponds to 630 grade 3 to 5 adverse events per 1000 participants with chemotherapy and 76 fewer (126 fewer to 25 fewer) grade 3 to 5 adverse events per 1000 participants with immunotherapy. We found no evidence for the outcome of time to death from bladder cancer. We are very uncertain if immunotherapy reduces the risk of disease progression (HR 0.99, 95% CI 0.84 to 1.16; I2 = 0%; 2 studies, 1473 participants; very low-certainty evidence). Immunotherapy may reduce discontinuations due to adverse events in participants undergoing second-line therapy (RR 0.35, 95% CI 0.17 to 0.72; I2 = 69%; 2 studies, 1473 participants; low-certainty evidence). This corresponds to 110 discontinuations per 1000 participants with chemotherapy and 72 fewer (91 fewer to 31 fewer) discontinuations per 1000 participants with immunotherapy. AUTHORS' CONCLUSIONS Compared to chemotherapy, immunotherapy for treating advanced or metastatic urothelial carcinoma probably has little to no effect on the risk of death from any cause when used as first-line therapy. Still, it may reduce the risk of death from any cause when used as second-line therapy. Health-related quality of life for participants receiving first- and second-line therapy does not appear to be affected by immunotherapy. Immunotherapy probably reduces or may reduce adverse events grade 3 to 5 when used as first- and second-line therapy, respectively.
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Affiliation(s)
- Philipp Maisch
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
- Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
| | - Kwangmin Kim
- Graduate school, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | | | - Caitlin Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, Minnesota, USA
| | - Frank Kunath
- Department of Urology and Pediatric Urology, Klinikum Bayreuth, Bayreuth, Germany
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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Chen HX, Huang CP. Oncological and functional outcome of robotic-assisted radical cystectomy with total intracorporeal stentless J-pouch neobladder reconstruction. Int J Med Robot 2023:e2583. [PMID: 37811801 DOI: 10.1002/rcs.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Robotic-assisted radical cystectomy (RARC) with neobladder reconstruction has gained popularity in recent years. METHODS We conducted a retrospective study of 17 consecutive patients who underwent RARC with totally intracorporeal J-pouch neobladder reconstruction without ureteral stent by a single experienced surgeon to evaluate perioperative, oncological and functional outcomes. RESULTS The median follow-up duration was 32.8 months (range: 17.4-59.0 months), and the 2-year disease-free survival rate was 88.2%. Five out of 12 patients were totally continent, and none required more than one pad per day. The overall complication rate was 41.2%, and hydronephrosis was the most common adverse event. The renal function remained stable, and no long-term renal function impairment was detected. CONCLUSION Our study suggests that RARC with totally intracorporeal J-pouch neobladder reconstruction without ureteral stent is a safe and feasible option for the treatment of muscle-invasive bladder cancer, with good oncological and functional outcomes.
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Affiliation(s)
- Hao Xiang Chen
- Department of Urology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Mahmoud O, Krafft U, Al-Nader M, Heß J, Kesch C, AbdelRazek M, Abolyosr A, Alsagheer GA, Mohamed O, Fathi A, Hadaschik BA, Tschirdewahn S. Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review. Arab J Urol 2023; 22:61-69. [PMID: 38205387 PMCID: PMC10776076 DOI: 10.1080/2090598x.2023.2239107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction Ureteroenteric stricture (UES) is the leading cause of renal function deterioration after radical cystectomy (RC) and urinary diversion (UD). The aim of the present review is to summarize studies that discussed the risk factors associated with UES development. Identifying the responsible factors is of importance to help surgeons to modify their treatment or follow-up strategies to reduce this serious complication. Materials and Methods A comprehensive search of the literature using the PubMed database was conducted. The target of the search was only studies that primarily aimed to identify risk factors of UES after RC and UD. References of searched papers were also checked for potential inclusion. Results The search originally yielded a total of 1357 articles, of which only 15 met our inclusion criteria, comprising 13, 481 patients. All the studies were observational, and retrospective published between 2013 and 2022. The natural history of UES and the reported risk factors varied widely across the studies. In 13 studies, a significant association between some risk factors and UES development was demonstrated. High body mass index (BMI) was the most frequently reported stricture risk factor, followed by perioperative urinary tract infection (UTI), robotic-assisted radical cystectomy (RARC), occurrence of post-operative Clavian grade ≥ 3 complications and urinary leakage. Otherwise, many other risk factors were reported only once. Conclusion The literature is still lacking well-designed prospective studies investigating predisposing factors of UES. The available data suggest that the high BMI, RARC and complicated postoperative course are the main risk factors for stricture formation.
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Affiliation(s)
- Osama Mahmoud
- Department of Urology, University Hospital Essen, Essen, Germany
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Mulham Al-Nader
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jochen Heß
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Mostafa AbdelRazek
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmad Abolyosr
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Gamal A Alsagheer
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Omar Mohamed
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Atef Fathi
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
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Borkowetz A. [Robot-assisted vs. laparoscopic vs. open radical cystectomy : Commentary on a systemic review and network meta-analysis of randomized, controlled trials]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:401-403. [PMID: 36810701 DOI: 10.1007/s00120-023-02041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Angelika Borkowetz
- Klinik und Poliklinik für Urologie, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
- UroEvidence@, Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
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Perioperative outcomes of open versus robot-assisted radical cystectomy in octogenarians: a population based analysis. J Robot Surg 2023:10.1007/s11701-023-01568-0. [PMID: 36933124 DOI: 10.1007/s11701-023-01568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
Octogenarians undergoing cystectomy experience higher morbidity and mortality compared to younger patients. Though the non-inferiority of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) has been established in a generalized population, the benefits of the robotic approach have not been well studied in an aged population. The National Cancer Database (NCDB) was queried for all patients who underwent cystectomy for bladder cancer from 2010 to 2016. Of these, 2527 were performed in patients age 80 or older; 1988 and 539 underwent ORC and RARC, respectively. On Cox regression analysis, RARC was associated with significantly reduced odds for both 30- and 90-day mortality (HR 0.404, p = 0.004; HR 0.694, p = 0.031, respectively), though the association with overall mortality was not significant (HR 0.877, p = 0.061). The robotic group had a significantly shorter length of stay (LOS) compared to open surgery (10.3 days ORC vs. 9.3 days RARC, p = 0.028). The proportion of cases performed robotically increased over the study period from 12.2% in 2010 to 28.4% in 2016 (p = 0.009, R2 = 0.774). The study is limited by a retrospective design and a section bias, which was not completely control for in the analysis. In conclusion, RARC provides improved perioperative outcomes in aged patients compared to ORC and a trend toward greater utilization of this technique was observed.
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Riveros C, Ranganathan S, Nipper C, Lim K, Brooks M, Dursun F, Miles BJ, Goh AC, Desai M, Klaassen Z, Kulkarni GS, Wallis CJ, Satkunasivam R. Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer A pairwise meta-analysis of outcomes and a network meta-analysis of complications. Can Urol Assoc J 2023; 17:E75-E85. [PMID: 36473475 PMCID: PMC10027355 DOI: 10.5489/cuaj.8096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (OR C) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction. METHODS MEDL INE, Embase, Scopus, the International Clinical Trials Registry Platform and ClinicalTrials.gov registries were searched in May 2022. Outcomes of interest included recurrence- or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT ), hospital length of stay (LOS ), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively. RESULTS We found no significant differences between RARC and OR C for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR ] 0.91, 95% confidence interval [CI] 0.67-1.23); positive surgical margins (odds ratio [OR ] 1.05, 95% CI 0.60-1.85); lymph node yield (mean difference [MD ] -0.63, 95% CI -2.63-1.37); LOS (MD -0.22, 95% CI -1.10-0.65); overall complications (OR 0.81, 95% CI 0.61-1.07); major complications (OR 0.94, 95% CI 0.69-1.30); readmissions (OR 0.90, 95% CI 0.60-1.35); and QoL (standardized MD -0.02, 95% CI -0.17-0.14). We found significantly lower EBL for RARC compared to OR C (MD -312.61, 95% CI -447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82-119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC. CONCLUSIONS This meta-analysis confirms the equivalence of RARC and OR C with respect to oncological outcomes.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Sanjana Ranganathan
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Cole Nipper
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Michael Brooks
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Furkan Dursun
- Department of Urology, University of Texas Health, San Antonio, TX, United States
| | - Brian J. Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Alvin C. Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States
| | - Mihir Desai
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Girish S. Kulkarni
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Christopher J.D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Urology, University of Toronto, Toronto, ON, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
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Aminoltejari K, Hird AE, Klaassen Z, Satkunasivam R, Kulkarni GS, Luckenbaugh AN, Laviana AA, Wallis CJD, Clark R. Robotic Versus Open Cystectomy for Bladder Cancer: Synthesizing the Data from Current Systematic Reviews and Meta-Analyses. Ann Surg Oncol 2023; 30:2976-2987. [PMID: 36774434 DOI: 10.1245/s10434-022-12692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/10/2022] [Indexed: 02/13/2023]
Abstract
This is a summary of existing systematic reviews comparing robotic assisted radical cystectomy (RARC) with open radical cystectomy (ORC). Our aim was to compare operative approaches with respect to perioperative, postoperative, oncologic, and health-related quality of life (QOL) outcomes. We performed a systematic review of MEDLINE, Medline-in-Process and Medline Epubs Ahead of Print, and the Cochrane Library on 22 February 2022. We included reviews of adult patients with bladder cancer undergoing RARC or ORC for muscle invasive or high-risk non-muscle invasive bladder cancer. Nonrandomized studies were excluded to minimize confounding and selection bias. The GRADE approach was used to determine the confidence in estimates. We assessed the quality of identified systematic reviews using AMSTAR 2 checklist. Six well-conducted, systematic reviews and meta-analyses were included. RARC was consistently associated with lower estimated blood loss (EBL) and transfusion rates, and longer operative time. There was inconsistent evidence for the impact of RARC on hospital length of stay (LOS). There was no significant difference in overall complication rate or major complication rate, or oncologic outcomes between groups. Comparison of QOL outcomes between studies was limited by statistical and methodological heterogeneity. RARC is associated with improvement in EBL and transfusion risk. There does not appear to be differences in oncologic outcomes or complications between approaches. Prospective studies are needed to assess the impact of diversion type, technique, and recovery pathways on patient outcomes and to assess the impact of operative approach on cost and patient-reported QOL.
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Affiliation(s)
- Khatereh Aminoltejari
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Amanda E Hird
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Zachary Klaassen
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Raj Satkunasivam
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Girish S Kulkarni
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Amy N Luckenbaugh
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Aaron A Laviana
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Christopher J D Wallis
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Roderick Clark
- Urologic Oncology, Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON, M5T 3L9, Canada.
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10
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von Deimling M, Laukhtina E, Pradere B, Pallauf M, Klemm J, Fisch M, Shariat SF, Rink M. Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges-a narrative review. Transl Androl Urol 2022; 11:1598-1610. [PMID: 36507477 PMCID: PMC9732696 DOI: 10.21037/tau-22-463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objective Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women. Methods We performed a non-systematic literature review of the available publications in the PubMed database. Key Content and Findings Over the past years, gender differences in oncological and functional outcomes after RC have received increased attention. According to the currently available literature, organ-sparing approaches can be safely performed in well-selected women without negatively impacting oncological outcomes. The orthotopic neobladder is feasible and oncologically safe in well-selected and informed women. The choice of the UD should be based on comprehensive counseling and the patient's comorbidities and preferences. There still is a lack of data on sexual recovery after the different surgical approaches aimed to mitigate sexual dysfunction in women undergoing RC. Conclusions Pre-and post-operative counseling and support of females undergoing RC regarding their expectations and experiences in terms of quality of life and functional and sexual outcomes are currently insufficient. Well-designed studies in this field are necessary to further improve outcomes of women treated with RC with an overarching aim to close the gender gap in managing women with bladder cancer.
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Affiliation(s)
- Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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McPhee A, Ridgway A, Bird T, Pal R, Rowe EW, Koupparis AJ, Aning JJ. The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot-assisted radical cystectomy and intracorporeal urinary diversion (RARC-ICUD). BJUI COMPASS 2022; 4:187-194. [PMID: 36816142 PMCID: PMC9931540 DOI: 10.1002/bco2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 09/04/2022] [Indexed: 02/17/2023] Open
Abstract
Objective The aim of this study was to investigate whether pre-operative comorbidity status measured by the Charlson comorbidity index (CCI) or cardiopulmonary exercise testing (CPET) is associated with postoperative complications and length of stay (LOS) in patients undergoing robot-assisted radical cystectomy and intracorporeal urinary diversion (RARC-ICUD). Patients and methods We conducted a retrospective study of a prospectively maintained database of 428 consecutive patients who underwent RARC-ICUD at a tertiary referral centre between 2011 and 2019. CCI was correlated with peri-operative outcomes including postoperative LOS, Clavien-Dindo (CD) complications and survival. A planned subgroup analysis was performed to evaluate the relationship between pre-operative CPET, and the same outcomes utilising the threshold of anaerobic threshold (AT) ≥ 11/ <11 ml/kg/min were analysed. Results Of the total cohort, 350 patients undergoing RARC-ICUD with complete data were included in the final analysis. A CCI score ≥5 was associated with a higher rate of CD III-V complications at 30-day incidence rate ratio (IRR) = 3.033, (p = 0.02) and at 90-day IRR 2.495, (p = 0.04) postsurgery. LOS was not associated with CCI; the strongest association with LOS was a CD complication of any grading. CCI did not predict readmission or mortality rates after surgery. Subanalyses of patients who underwent pre-operative CPET found that CPET <11 ml/kg/min did not predict for LOS, CD complications or death within 1 year of surgery. Conclusions CCI score is a simple, reliable and cost-effective way of identifying patients at increased risk of complication after RARC-ICUD. Surgeons performing radical cystectomy should consider utilising CCI to augment pre-operative patient counselling prior to RARC-ICUD.
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Affiliation(s)
- Arthur McPhee
- Bristol Urological Institute, North Bristol NHS TrustSouthmead HospitalBristolUK,Department of UrologyAddenbrooke's HospitalCambridgeUK
| | - Alexander Ridgway
- Bristol Urological Institute, North Bristol NHS TrustSouthmead HospitalBristolUK
| | - Thomas Bird
- Bristol Haematology and Oncology CentreUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Raj Pal
- Bristol Urological Institute, North Bristol NHS TrustSouthmead HospitalBristolUK
| | - Edward W. Rowe
- Bristol Urological Institute, North Bristol NHS TrustSouthmead HospitalBristolUK
| | - Anthony J. Koupparis
- Bristol Urological Institute, North Bristol NHS TrustSouthmead HospitalBristolUK
| | - Jonathan J. Aning
- Bristol Urological Institute, North Bristol NHS TrustSouthmead HospitalBristolUK,Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
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12
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Omorphos NP, Ghose A, Hayes JD, Kandala A, Dasgupta P, Sharma A, Vasdev N. The increasing indications of FDG-PET/CT in the staging and management of Invasive Bladder Cancer. Urol Oncol 2022; 40:434-441. [DOI: 10.1016/j.urolonc.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/20/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
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13
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Tanabe K, Nakanishi Y, Umino Y, Okubo N, Kataoka M, Yajima S, Masuda H. Validity and Safety of Robot-Assisted Laparoscopic Radical Cystectomy for the Elderly: Results of Perioperative Outcomes in Patients Aged ≥80 Years. Turk J Urol 2022; 48:322-330. [PMID: 36197139 PMCID: PMC9623346 DOI: 10.5152/tud.2022.22099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To improve perioperative outcomes, robot-assisted radical cystectomy has gained increasing interest. This study aimed to assess the detailed perioperative complications of robot-assisted radical cystectomy in elderly aged ≥80 years and compare them with those of non-elderly. MATERIAL AND METHODS We retrospectively analyzed the clinical features of 74 patients who underwent robotassisted radical cystectomy for bladder cancer between September 2018 and September 2021. Perioperative complication was classified by the Clavien-Dindo classification and organ system-based categories. We assessed the relationship between age or Charlson comorbidity index score (≥3 or <3) and the incidence of perioperative complication or rehospitalization rate within 90 days postoperatively. RESULTS Of the 74 patients, perioperative complication of all grades and grade ≥IIIa occurred in 54 (73%) and 15 (20%) patients, respectively. The postoperative rehospitalization rate was 20%, and the perioperative mortality rate was 0%. Elderly (n = 20) showed no difference in the incidence of perioperative complication of all grades or grade ≥IIIa compared with non-elderly, and no organ system-based category had a higher incidence in elderly than that in non-elderly. Gastrointestinal tract-related perioperative complication incidence was higher in non-elderly and those with Charlson comorbidity index ≥3 (P = .044, .039, respectively); cardi ovasc ular- relat ed perioperative complication incidence was higher in those with Charlson comorbidity index ≥ 3 (P = .0068). CONCLUSION The incidence perioperative complication of robot-assisted radical cystectomy in elderly was not different from those in non-elderly, suggesting that robot-assisted radical cystectomy may be an option for the treatment of bladder cancer in elderly as well as non-elderly.
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14
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Vejlgaard M, Maibom SL, Joensen UN, Thind PO, Rohrsted M, Aasvang EK, Kehlet H, Røder MA. Quality of life and secondary outcomes for open versus robot-assisted radical cystectomy: a double-blinded, randomised feasibility trial. World J Urol 2022; 40:1669-1677. [PMID: 35590011 DOI: 10.1007/s00345-022-04029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/23/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aims to examine quality of life (QoL) before and after radical cystectomy (RC) and compare robot-assisted laparoscopy with intracorporeal urinary diversion (iRARC) to open radical cystectomy (ORC). METHODS This study is a predefined secondary analysis of a single-centre, double-blinded, randomised feasibility trial. Fifty patients were randomly assigned to iRARC with ileal conduit (n = 25) or ORC with ileal conduit (n = 25). Patients were followed 90 days postoperatively. The primary outcome was patient-reported QoL using the EORTC Cancer-30 and muscle-invasive bladder cancer BLM-30 QoL questionnaires before and after RC. Differences between randomisation arms as well as changes over time were evaluated. Secondary outcomes included 30- and 90 day complication rates, 90 day readmission rates, and 90 day days-alive-and-out-of-hospital and their relationship to QoL. RESULTS All patients underwent the allocated treatment. We found no difference in QoL, complication rates, readmission rates, and days-alive-and-out-of-hospital between randomisation arms. An overall improvement in QoL was found in the following domains: future perspectives, emotional functioning, and social functioning. Sexual functioning worsened postoperatively. There was no association between having experienced a major complication or lengthy hospitalisation and worse postoperative QoL. CONCLUSION The QoL does not appear to depend on surgical technique. Apart from sexual functioning, patients report stable or improved QoL within the first 90 postoperative days.
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Affiliation(s)
- Maja Vejlgaard
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Ole Maaloes Vej 24, unit 7521, DK-2100, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sophia Liff Maibom
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Ole Maaloes Vej 24, unit 7521, DK-2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Ole Maaloes Vej 24, unit 7521, DK-2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Ole Thind
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Malene Rohrsted
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske Kvanner Aasvang
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Ole Maaloes Vej 24, unit 7521, DK-2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Busetto GM, D’Agostino D, Colicchia M, Palmer K, Artibani W, Antonelli A, Bianchi L, Bocciardi A, Brunocilla E, Carini M, Carrieri G, Cormio L, Falagario UG, De Berardinis E, Sciarra A, Leonardo C, Del Giudice F, Maggi M, de Cobelli O, Ferro M, Musi G, Ercolino A, Di Maida F, Gallina A, Introini C, Mearini E, Cochetti G, Minervini A, Montorsi F, Schiavina R, Serni S, Simeone C, Parma P, Serao A, Mangano MS, Pomara G, Ditonno P, Simonato A, Romagnoli D, Crestani A, Porreca A. Robot-Assisted, Laparoscopic, and Open Radical Cystectomy: Pre-Operative Data of 1400 Patients From The Italian Radical Cystectomy Registry. Front Oncol 2022; 12:895460. [PMID: 35600337 PMCID: PMC9117739 DOI: 10.3389/fonc.2022.895460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction The Italian Radical Cystectomy Registry (RIC) is an observational prospective study aiming to understand clinical variables and patient characteristics associated with short- and long-term outcomes among bladder cancer (BC) patients undergoing radical cystectomy (RC). Moreover, it compares the effectiveness of three RC techniques - open, robotic, and laparoscopic. Methods From 2017 to 2020, 1400 patients were enrolled at one of the 28 centers across Italy. Patient characteristics, as well as preoperative, postoperative, and follow-up (3, 6, 12, and 24 months) clinical variables and outcomes were collected. Results Preoperatively, it was found that patients undergoing robotic procedures were younger (p<.001) and more likely to have undergone preoperative neoadjuvant chemotherapy (p<.001) and BCG instillation (p<.001). Hypertension was the most common comorbidity among all patients (55%), and overall, patients undergoing open and laparoscopic RC had a higher Charlson Comorbidities Index (CCI) compared to robotic RC (p<.001). Finally, laparoscopic patients had a lower G-stage classification (p=.003) and open patients had a higher ASA score (p<.001). Conclusion The present study summarizes the characteristic of patients included in the RIC. Future results will provide invaluable information about outcomes among BC patients undergoing RC. This will inform physicians about the best techniques and course of care based on patient clinical factors and characteristics.
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Affiliation(s)
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
- *Correspondence: Gian Maria Busetto,
| | | | | | - Katie Palmer
- Department of Internal Medicine and Geriatrics, University Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | | | - Marco Carini
- Department of Urology, University of Florence, Florence, Italy
| | | | - Luigi Cormio
- Department of Urology, Villa Salus Clinic, Mestre, Italy
| | | | - Ettore De Berardinis
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Amelio Ercolino
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Andrea Gallina
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | | | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | | | | | - Francesco Montorsi
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | | | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | - Paolo Parma
- Department of Urology, Azienda Socio Sanitaria Territoriale (ASST) Mantova, Mantova, Italy
| | - Armando Serao
- Department of Urology, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | | | - Giorgio Pomara
- Department of Urology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | | | - Alessandro Crestani
- Oncological Urology, Veneto Institute of Oncology (IOV) – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV) – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
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Mortezavi A, Crippa A, Kotopouli MI, Akre O, Wiklund P, Hosseini A. Association of Open vs Robot-Assisted Radical Cystectomy With Mortality and Perioperative Outcomes Among Patients With Bladder Cancer in Sweden. JAMA Netw Open 2022; 5:e228959. [PMID: 35482309 PMCID: PMC9051984 DOI: 10.1001/jamanetworkopen.2022.8959] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Mortality rates resulting from bladder cancer have remained unchanged for more than 30 years. The surgical community has put hope in robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in an effort to improve surgical outcomes and bladder cancer survival without strong supporting evidence. OBJECTIVE To evaluate perioperative, safety, and survival outcome differences between RARC with ICUD and open radical cystectomy (ORC). DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cohort study used data from the Swedish National Register of Urinary Bladder Cancer and population-based Cause of Death Register, which includes clinical information on tumor characteristics, treatment, and survival and covers approximately 97% of patients with urinary bladder cancer in Sweden. All patients who underwent radical cystectomy for bladder cancer in any hospital between January 2011 and December 2018 were included. Follow-up data were collected until December 2019. Data analysis was conducted from June to December 2020. EXPOSURES RARC or ORC. MAIN OUTCOMES AND MEASURES The main outcomes were all-cause and cancer-specific mortality between RARC and ORC, compared using propensity score matching. Secondary outcomes were differences in perioperative outcomes after the different surgical approaches. RESULTS Throughout the observation period, 889 patients underwent RARC and 2280 patients underwent ORC at 24 Swedish hospitals. The median (IQR) age was 71 (66-76) years and 2386 patients (75.3%) were men. After a median (IQR) follow-up of 47 (28-71) months, the 5-year cancer-specific mortality rates were 30.2% (variance, 1.59) for ORC and 27.6% (variance, 3.12) for RARC, and the overall survival rates were 57.7% (variance, 2.46) for ORC and 61.4% (variance, 5.11) for RARC. In the propensity score-matched analysis, RARC was associated with a lower all-cause mortality (hazard ratio, 0.71; 95% CI, 0.56-0.89; P = .004). Compared with ORC, RARC was associated with a lower estimated blood loss (median [IQR] 150 [100-300] mL vs 700 [400-1300] mL; P < .001), intraoperative transfusion rate (odds ratio [OR], 0.05; 95% CI, 0.03-0.08; P < .001), and shorter length of stay (median [IQR], 9 [6-13] days vs 13 [10-17] days; P < .001), and with a higher lymph node yield (median [IQR], 20 [15-27] lymph nodes vs 14 [8-24] lymph nodes; P < .001) and 90-day rehospitalization rate (OR, 1.28; 95% CI, 1.02-1.60; P = .03). The RARC group, compared with the ORC group had lower risk of Clavien-Dindo grade III or higher complications (OR, 0.62; 95% CI, 0.43-0.87; P = .009). CONCLUSIONS AND RELEVANCE These findings suggest that compared with ORC, RARC with ICUD was associated with a lower overall mortality rate, fewer high-grade complications, and more favorable perioperative outcomes.
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Affiliation(s)
- Ashkan Mortezavi
- Department of Urology, University Hospital Basel, Basel, Switzerland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Ioanna Kotopouli
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Solna, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Surgery, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Surgery, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Surgery, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Mally D, Pfister D, Heidenreich A, Albers P, Niegisch G. [Does robotic radical cystectomy affect oncological outcomes in bladder cancer patients?]. Aktuelle Urol 2022; 53:153-158. [PMID: 35345013 DOI: 10.1055/a-1745-8521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.
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Affiliation(s)
- David Mally
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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18
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Gallioli A, Pradere B, Albisinni S, Moschini M. Robot-assisted radical cystectomy: towards a future of sexual-sparing surgery? Minerva Urol Nephrol 2022; 73:697-699. [PMID: 35144367 DOI: 10.23736/s2724-6051.21.04824-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea Gallioli
- Puigvert Foundation, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain -
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Simone Albisinni
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marco Moschini
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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19
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Benchmarking PASADENA Consensus along the Learning Curve of Robotic Radical Cystectomy with Intracorporeal Neobladder: CUSUM Based Assessment. J Clin Med 2021; 10:jcm10245969. [PMID: 34945265 PMCID: PMC8706610 DOI: 10.3390/jcm10245969] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/21/2023] Open
Abstract
(1) Aim: Robot assisted radical cystectomy (RARC) with intacorporeal neobladder (iN) is a challenging procedure. There is a paucity of reports on RARC-iN, the extracorporeal approach being the most used. The aim of our study was to assess the learning curve of RARC-iN and to test its performance in benchmarking Pasadena consensus outcomes. (2) Material and methods: The single-institution learning curve of RARC-iN was retrospectively evaluated. Demographic, clinical and pathologic data of all patients were recorded. Indications to radical cystectomy included muscle invasive bladder cancer (pT ≥ 2) or recurrent high grade non muscle invasive bladder cancer. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted by the medical field in the 1970s to analyze learning curves for surgical procedures. The learning curve was evaluated using the following criteria: 1. operative time (OT) <5 h; 2. 24-h Hemoglobin (Hb) drop <2 g/dl; 3. severe complications (according to the Clavien classification system) <30%; 4. positive surgical margins <5%; and 5. complete lymph-node dissection defined as more than 16 nodes. Benchmarking of all five items on quintile analysis was tested, and a failure rate <20% for any outcome was set as threshold. (3) Results: the first 100 consecutive RARC-iN patients were included in the analysis. At CUSUM analysis, RARC required 20 cases to achieve a plateau in terms of operative time (defined as more than 3 consecutive procedures below 300 min). Hemoglobin drop, PSM and number of removed lymph-nodes did not change significantly along the learning curve. Overall, 41% of the patients presented at least one complication. Low-grade and high-grade complication rates were 30% and 17%, respectively. When assessing the benchmarks of all five Pasadena consensus outcomes on quintile analysis, a plateau was achieved after the first 60 cases. (4) Conclusions: RARC-iN is a challenging procedure. The potential impact of the learning curve on significant outcomes, such as high grade complications and positive surgical margins, has played a detrimental effect on its widespread adoption. According to this study, in tertiary referral centers, 60 procedures are sufficient to benchmark all outcomes defined in Pasadena RARC consensus.
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Videourology Abstracts. J Endourol 2021. [DOI: 10.1089/end.2021.29120.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Bai Y, Wang S, Zheng W, Li E, Quan J, Wei F, Zhang Q, Qi X, Zhang D. Clinical outcome of laparoscopic versus robot-assisted radical cystectomy for patients with bladder cancer: a retrospective study. BMC Surg 2021; 21:388. [PMID: 34727908 PMCID: PMC8561927 DOI: 10.1186/s12893-021-01382-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background With the development of minimally invasive surgery technology, patients with bladder cancer are increasingly receiving laparoscopic radical cystectomy (LRC) or robotic-assisted radical cystectomy (RARC) treatment. The main purpose of this study was to compare the long-term outcomes of bladder cancer patients treated with LRC versus RARC. Methods A retrospective study to identify patients with clinical stage Ta/T1/Tis to T3 bladder cancer who underwent RARC or LRC has been performed. The perioperative outcome, recurrence, and overall survival (OS) of the two surgical methods were compared. Results 218 patients were identified from March 2010 to December 2019 in our department, which including 82 (38%) patients who received LRC and 136 (62%) patients who received RARC. There was no significant difference between the two groups in terms of lymph node collection, lymph node positive rate, resection margin positive rate, and postoperative pathological staging. Compared with the LRC group, patients in the RARC group had a median estimated blood loss (180 vs. 250 ml; P = 0.02) and reduced complications at 90 days postoperatively (30.8% vs. 46.3%; P = 0.01). Recurrence, all-cause death, and cancer-specific death occurred in 77 (35%), 55 (25%), and 39 (18%) patients, respectively. The 5-year OS rate was 54.63% and 54.65% in the RARC and LRC group (P > 0.05). The 5-year cancer-specific survival (CSS) rate was 73.32% and 61.55% in RARC and LRC group (P > 0.05). There was no significant difference in OS [hazard ratio (HR) 1.083, 95% confidence interval (CI) 0.626–1.874; P = 0.78], and CSS (HR 0.789, 95%CI 0.411–1.515; P = 0.61) between two groups. Conclusions Both RARC and LRC were safe and effective with a similar long-term clinical outcomes. Moreover, RARC had significantly lower median estimated blood loss and reduced postoperative complications.
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Affiliation(s)
- Yuchen Bai
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - Shuai Wang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - Wei Zheng
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - EnHui Li
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - Jing Quan
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - Fei Wei
- Graduate Department, Bengbu Medical College, Bengbu, 233000, Anhui, China
| | - Qi Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - XiaoLong Qi
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China
| | - DaHong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 138 ShangTang Road, Hangzhou, 310014, China.
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Abstract
Radical cystectomy is the standard of care for patients with nonmetastatic high-risk bladder cancer. Robotic approach to radical cystectomy has been developed to reduce perioperative morbidities and enhance postoperative recovery while maintaining oncologic control. Classically, radical cystectomy in female patient entails anterior pelvic exenteration with removal of the bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra. Pelvic organ-sparing radical cystectomy has been adopted in carefully selected patients to optimize postoperative sexual and urinary function, especially in those undergoing orthotopic urinary diversion. In this article, we describe our techniques of both classical and organ-sparing robot-assisted laparoscopic radical cystectomy in female patients. We also review patient selection criteria, perioperative management, and alternative approaches to improve operative outcomes in female patients.
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Affiliation(s)
- Hong Truong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Victoria Maxon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alvin C Goh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Salehi-Pourmehr H, Naseri A, Mostafaei A, Vahedi L, Sajjadi S, Tayebi S, Mostafaei H, Hajebrahimi S. Misconduct in research integrity: Assessment the quality of systematic reviews in Cochrane urological cancer review group. Turk J Urol 2021; 47:392-419. [PMID: 35118979 PMCID: PMC9612768 DOI: 10.5152/tud.2021.21038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Cochrane Library provides a powerful and authoritative database to aid medical decision making. We aimed to evaluate the quality of clinical trials and systematic reviews recorded in the Cochrane urology cancers group. MATERIAL AND METHODS This analytic cross-sectional study was conducted on 44 published systematic reviews of the Cochrane urology group which were published until May 2020. In the current study, we selected the urological cancer reviews. All types of biases in the understudied randomized controlled trials (RCTs) or quasi-RCTs of these systematic reviews were evaluated using the Cochrane appraisal checklist. We also separated and stratified the types of biases in the included studies. In addition, the quality of systematic reviews was assessed using the Joanna Briggs Institute (JBI) appraisal checklist. RESULTS A total of 44 systematic reviews and their understudied 340 RCTs were evaluated. On the basis of the JBI appraisal checklist results, 93.2% of systematic reviews had high quality. In terms of the quality of understudied RCTs in these reviews, the common prevalent risk of bias of the understudied RCTs or quasi- RCTs was unclear selection bias (allocation concealment and random sequence generation). The highest risk of bias was seen in the blinding of participants and personnel (performance bias). CONCLUSION Although most Cochrane urological cancer reviews had high quality, performance bias was the highest one in their understudied RCTs. Regarding it and considering the increasing unclear risk of detection, attrition, and reporting biases, it is obvious that they have structural deficiencies; therefore, it is recommended to observe integrity principles for preventing research misconduct.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Leila Vahedi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sana Sajjadi
- Islamic Azad University Marand Branch, Marand, Iran
| | - Sona Tayebi
- Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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A comparative study of perioperative and survival outcomes of robot-assisted radical cystectomy in patients over 80 and under 80 years old. World J Surg Oncol 2021; 19:202. [PMID: 34229712 PMCID: PMC8262028 DOI: 10.1186/s12957-021-02312-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022] Open
Abstract
Background Radical cystectomy (RC) is the standard treatment for bladder cancer, but the safety and efficacy of this treatment for elderly people need to be considered. We compare perioperative data and survival outcomes between elderly (≥80 years) and younger (<80 years) patients undergoing robot-assisted radical cystectomy (RARC). Methods We reviewed demographic, perioperative clinical and follow-up data of 190 consecutive patients with urothelial carcinoma of bladder who received RARC from May 2015 to December 2018 in Nanjing Drum Tower Hospital. The patients were divided into 2 groups by age: ≥80 years and <80 years. Perioperative outcomes were compared between 2 groups. Logistic regression method was used to analyze the factors that may affect preoperative complications. Cox regression model was employed to analyze the factors affecting 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Results Of the 190 patients, 44 (23.2%) were octogenarians. The elderly patients did not statistically differ from younger patients in most of the demographic, perioperative, and pathological information. American Society of Anesthesiologists (ASA) score (p=0.045) and Charlson comorbidity index (CCI) (p=0.035) could predict high-grade and any grade complications, respectively. Positive lymph node and pT≥3 were main factors affecting OS, RFS, and CSS. ASA score (p=0.048) and CCI (p=0.003) could predict OS and RFS, respectively. Elderly group had worse OS (p=0.007) and CSS (p=0.027) but similar RFS (p=0.147) compared with younger group. Conclusion The elderly who received RARC had similar risk of perioperative complications and RFS compared with younger patients. RARC could be an alternative treatment for selected octogenarians.
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Orthotopic urinary diversions after radical cystectomy for bladder cancer: lessons learned last decade. Curr Opin Urol 2021; 31:580-585. [PMID: 34175877 DOI: 10.1097/mou.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Orthotopic urinary diversion (OUD), or neobladder, is believed to be the gold standard for surgical bladder reconstruction following radical cystectomy though it is performed far less often than ileal conduits. As both a continent and intracavitary diversion, OUDs offer unique advantages for patients. Their utilization has decreased overall though, especially with the advent of robotic surgery. In this review, we will cover patient selection for OUD, functional outcomes (i.e., continence, sexual activity, quality of life [QoL]), and robotic orthotopic diversions. RECENT FINDINGS OUDs have seen a proportionally greater decline in utilization compared with ileal conduits as the number of robotic radical cystectomies being performed with intracorporeal diversions increases. Multiple robotic series have demonstrated less perioperative blood loss and shorter hospital stays when compared with the open approach though operative times are longer, the learning curve is steeper, and overall costs may be higher in some settings. Perioperative safety and short-term oncological outcomes appear comparable. Since robotic OUDs are relatively new, functional outcomes are not yet well established. Patient satisfaction with urinary diversion is associated with informed decision-making tailored to the patient. A thorough understanding of expected short- and long-term functional outcomes and the care required to maintain an OUD improves QoL and satisfaction with diversion choice. SUMMARY Given the potential advantages of OUD, its decreasing use is a remarkable trend. Shared decision-making and a patient-centered approach should be used when selecting the type of urinary diversion.
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Teoh JYC, Chan EOT, Kang SH, Patel MI, Muto S, Yang CK, Hatakeyama S, Chow TSF, Mok A, Zhang R, Kijvikai K, Lee LS, Chen H, Ohyama C, Horie S, Chan ESY. Perioperative Outcomes of Robot-Assisted Radical Cystectomy with Intracorporeal Versus Extracorporeal Urinary Diversion. Ann Surg Oncol 2021; 28:9209-9215. [PMID: 34152523 DOI: 10.1245/s10434-021-10295-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to investigate and compare the perioperative outcomes of intracorporeal urinary diversion (ICUD) versus extracorporeal urinary diversion (ECUD) following robotic-assisted radical cystectomy (RARC) in patients with localized bladder cancer from the Asian Robot-Assisted Radical Cystectomy (RARC) Consortium. METHODS The Asian RARC registry was a multicenter registry involving nine centers in Asia. Consecutive patients who underwent RARC were included. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed and compared between the ICUD and ECUD groups. Postoperative complications were the primary outcomes, whereas secondary outcomes were the estimated blood loss and the duration of hospitalization. Multivariate regression analyses were performed to adjust potential confounders. RESULTS From 2007 to 2020, 556 patients underwent RARC; 55.2% and 44.8% had ICUD and ECUD, respectively. ICUD group had less estimated blood loss (423.1 ± 361.1 vs. 541.3 ± 474.3 mL, p = 0.002) and a shorter hospital stay (15.7 ± 12.3 vs 17.8 ± 11.6 days, p = 0.042) than the ECUD group. Overall complication rates were similar between the two groups. Upon multivariate analysis, ICUD was associated with less estimated blood loss (Regression coefficient: - 143.06, 95% confidence interval [CI]: - 229.60 to - 56.52, p = 0.001) and a shorter hospital stay (Regression coefficient: - 2.37, 95% CI: - 4.69 to - 0.05, p = 0.046). In addition, ICUD was not associated with any increased risks of minor, major, and overall complications. CONCLUSIONS RARC with ICUD was safe and technically feasible with similar postoperative complication rates as ECUD, with additional benefits of reduced blood loss and a shorter hospitalization.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,European Association of Urology Young Academic Urologists, Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands.
| | - Erica On-Ting Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Seok-Ho Kang
- Department of Urology, School of Medicine, Korea University, Seoul, Republic of Korea
| | - Manish I Patel
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Satoru Muto
- Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Timothy Shing-Fung Chow
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Mok
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruiyun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lui-Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore.,Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeo Horie
- Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
| | - Eddie Shu-Yin Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Artificial Intelligence and Its Impact on Urological Diseases and Management: A Comprehensive Review of the Literature. J Clin Med 2021; 10:jcm10091864. [PMID: 33925767 PMCID: PMC8123407 DOI: 10.3390/jcm10091864] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Recent advances in artificial intelligence (AI) have certainly had a significant impact on the healthcare industry. In urology, AI has been widely adopted to deal with numerous disorders, irrespective of their severity, extending from conditions such as benign prostate hyperplasia to critical illnesses such as urothelial and prostate cancer. In this article, we aim to discuss how algorithms and techniques of artificial intelligence are equipped in the field of urology to detect, treat, and estimate the outcomes of urological diseases. Furthermore, we explain the advantages that come from using AI over any existing traditional methods.
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McBride K, Steffens D, Stanislaus C, Solomon M, Anderson T, Thanigasalam R, Leslie S, Bannon PG. Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload. BMC Health Serv Res 2021; 21:108. [PMID: 33522941 PMCID: PMC7849115 DOI: 10.1186/s12913-021-06105-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. Results Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06105-z.
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Affiliation(s)
- Kate McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia. .,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christina Stanislaus
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Michael Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Teresa Anderson
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul G Bannon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The Baird Institute, Sydney, New South Wales, Australia
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Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, Bivalacqua TJ, Montgomery JS, Lerner SP, Busby JE, Poch M, Crispen PL, Steinberg GD, Schuckman AK, Downs TM, Svatek RS, Mashni J, Lane BR, Guzzo TJ, Bratslavsky G, Karsh LI, Woods ME, Brown G, Canter D, Luchey A, Lotan Y, Krupski T, Inman BA, Williams MB, Cookson MS, Keegan KA, Andriole GL, Sankin AI, Boyd A, O'Donnell MA, Sawutz D, Philipson R, Coll R, Narayan VM, Treasure FP, Yla-Herttuala S, Parker NR, Dinney CPN. Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial. Lancet Oncol 2021; 22:107-117. [PMID: 33253641 PMCID: PMC7988888 DOI: 10.1016/s1470-2045(20)30540-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND BCG is the most effective therapy for high-risk non-muscle-invasive bladder cancer. Nadofaragene firadenovec (also known as rAd-IFNa/Syn3) is a replication-deficient recombinant adenovirus that delivers human interferon alfa-2b cDNA into the bladder epithelium, and a novel intravesical therapy for BCG-unresponsive non-muscle-invasive bladder cancer. We aimed to evaluate its efficacy in patients with BCG-unresponsive non-muscle-invasive bladder cancer. METHODS In this phase 3, multicentre, open-label, repeat-dose study done in 33 centres (hospitals and clinics) in the USA, we recruited patients aged 18 years or older, with BCG-unresponsive non-muscle-invasive bladder cancer and an Eastern Cooperative Oncology Group status of 2 or less. Patients were excluded if they had upper urinary tract disease, urothelial carcinoma within the prostatic urethra, lymphovascular invasion, micropapillary disease, or hydronephrosis. Eligible patients received a single intravesical 75 mL dose of nadofaragene firadenovec (3 × 1011 viral particles per mL). Repeat dosing at months 3, 6, and 9 was done in the absence of high-grade recurrence. The primary endpoint was complete response at any time in patients with carcinoma in situ (with or without a high-grade Ta or T1 tumour). The null hypothesis specified a complete response rate of less than 27% in this cohort. Efficacy analyses were done on the per-protocol population, to include only patients strictly meeting the BCG-unresponsive definition. Safety analyses were done in all patients who received at least one dose of treatment. The study is ongoing, with a planned 4-year treatment and monitoring phase. This study is registered with ClinicalTrials.gov, NCT02773849. FINDINGS Between Sept 19, 2016, and May 24, 2019, 198 patients were assessed for eligibility. 41 patients were excluded, and 157 were enrolled and received at least one dose of the study drug. Six patients did not meet the definition of BCG-unresponsive non-muscle-invasive bladder cancer and were therefore excluded from efficacy analyses; the remaining 151 patients were included in the per-protocol efficacy analyses. 55 (53·4%) of 103 patients with carcinoma in situ (with or without a high-grade Ta or T1 tumour) had a complete response within 3 months of the first dose and this response was maintained in 25 (45·5%) of 55 patients at 12 months. Micturition urgency was the most common grade 3-4 study drug-related adverse event (two [1%] of 157 patients, both grade 3), and there were no treatment-related deaths. INTERPRETATION Intravesical nadofaragene firadenovec was efficacious, with a favourable benefit:risk ratio, in patients with BCG-unresponsive non-muscle-invasive bladder cancer. This represents a novel treatment option in a therapeutically challenging disease state. FUNDING FKD Therapies Oy.
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Affiliation(s)
| | | | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Seth P Lerner
- Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Joseph E Busby
- Cancer Centers of the Carolinas, Greenville Hospital System, Greenville, SC, USA
| | - Michael Poch
- Department of GU Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Paul L Crispen
- Department of Urology, University of Florida, Gainesville, FL, USA
| | - Gary D Steinberg
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Anne K Schuckman
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Tracy M Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Brian R Lane
- Division of Urology, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Thomas J Guzzo
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Michael E Woods
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Adam Luchey
- West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Krupski
- Department of Urology, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Brant A Inman
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Michael S Cookson
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kirk A Keegan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald L Andriole
- Washington University School of Medicine in St Louis, St Louis, MO, USA
| | | | | | | | | | | | | | - Vikram M Narayan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Seppo Yla-Herttuala
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Nigel R Parker
- AI Virtanen Institute University of Eastern Finland and Science Service Center and Gene Therapy Unit, Kuopio, Finland
| | - Colin P N Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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30
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Brodie A, Kijvikai K, Decaestecker K, Vasdev N. Review of the evidence for robotic-assisted robotic cystectomy and intra-corporeal urinary diversion in bladder cancer. Transl Androl Urol 2020; 9:2946-2955. [PMID: 33457267 PMCID: PMC7807361 DOI: 10.21037/tau.2019.12.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Radical cystectomy, pelvic lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. The surgery is both complex and highly morbid. Robotic cystectomy is now in its 16th year with established techniques and sufficient research maturity to enable comparison with its open counterpart. The present review focuses on the current evidence for robotic cystectomy and assesses various metrics including oncological, perioperative, functional, surgeon-specific and cost outcomes. The review also encapsulates the current evidence for intra-corporeal urinary diversion and its current status in the cystectomy arena.
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Affiliation(s)
- Andrew Brodie
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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Aminoltejari K, Black PC. Radical cystectomy: a review of techniques, developments and controversies. Transl Androl Urol 2020; 9:3073-3081. [PMID: 33457280 PMCID: PMC7807330 DOI: 10.21037/tau.2020.03.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Radical cystectomy (RC) with urinary diversion is considered the standard treatment for muscle invasive bladder cancer (MIBC). As one of the most challenging surgical techniques performed by urologists, RC was described many decades ago, and yet patient morbidity rates have remained stagnant over the years. This review outlines the most recent indications and techniques for RC and analyses the current landscape of complications after cystectomy. There is significant room for improvement with respect to both oncologic and functional outcomes after RC. Future efforts will need to focus on unifying reporting methodology, optimal patient selection criteria, enhanced surgical techniques and peri-operative care pathways, and technological advances to improve patient outcomes.
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Affiliation(s)
- Khatereh Aminoltejari
- Department of Urologic Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Mortezavi A, Crippa A, Edeling S, Pokupic S, Dell'Oglio P, Montorsi F, D'Hondt F, Mottrie A, Decaestecker K, Wijburg CJ, Collins J, Kelly JD, Tan WS, Sridhar A, John H, Canda AE, Schwentner C, Rönmark EP, Wiklund P, Hosseini A. Morbidity and mortality after robot-assisted radical cystectomy with intracorporeal urinary diversion in octogenarians: results from the European Association of Urology Robotic Urology Section Scientific Working Group. BJU Int 2020; 127:585-595. [PMID: 33058469 PMCID: PMC8246851 DOI: 10.1111/bju.15274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians. Patients and Methods We conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890 patients who underwent RARC with ICUD for bladder cancer between 2004 and 2018 in 10 European centres. Outcomes of patients aged <80 years and those aged ≥80 years were compared with regard to postoperative complications (Clavien–Dindo grading) and mortality rate. Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) after surgery were calculated using the non‐parametric Aalen‐Johansen estimator. Results A total of 1726 patients aged <80 years and 164 aged ≥80 years were included in the analysis. The 30‐ and 90‐day rate for high‐grade (Clavien–Dindo grades III–V) complications were 15% and 21% for patients aged <80 years compared to 11% and 13% for patients aged ≥80 years (P = 0.2 and P = 0.03), respectively. In a multivariable logistic regression analysis adjusting for pre‐ and postoperative variables, age ≥80 years was not an independent predictor of high‐grade complications (odds ratio 0.6, 95% confidence interval 0.3–1.1; P = 0.12). The non‐cancer‐related 90‐day mortality was 2.3% for patients aged ≥80 years and 1.8% for those aged <80 years, respectively (P = 0.7). The estimated 12‐month CSM and OCM rates for those aged <80 years were 8% and 3%, and for those aged ≥80 years, 15% and 8%, respectively (P = 0.009 and P < 0.001). Conclusions The minimally invasive approach to RARC with ICUD for bladder cancer in well‐selected elderly patients (aged ≥80 years) achieved a tolerable high‐grade complication rate; the 90‐day postoperative mortality rate was driven by cancer progression and the non‐cancer‐related rate was equivalent to that of patients aged <80 years. However, an increased OCM rate in this elderly group after the first year should be taken into account. These results will support clinicians and patients when balancing cancer‐related vs treatment‐related risks and benefits.
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Affiliation(s)
- Ashkan Mortezavi
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, University Hospital Zurich, Zurich, Switzerland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Edeling
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Sasa Pokupic
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Paolo Dell'Oglio
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | | | - Carl J Wijburg
- Department of Urology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Justin Collins
- Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Department of Urology, University College London Hospital, London, UK
| | - Wei Shen Tan
- Department of Urology, University College London Hospital, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospital, London, UK
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | | | - Erik Peder Rönmark
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
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Jensen BT, Lauridsen SV, Jensen JB. Optimal Delivery of Follow-Up Care After Radical Cystectomy for Bladder Cancer. Res Rep Urol 2020; 12:471-486. [PMID: 33117747 PMCID: PMC7569073 DOI: 10.2147/rru.s270240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose of Review To identify components representing optimal delivery of follow-up care after radical cystectomy because of bladder cancer and report the current level of evidence. Methods We conducted a systematic literature search of the following databases: Cochrane, MEDLINE, Embase, CINAHL, Web of Science, Physiotherapy Evidence Database and ClinicalTrials.gov. The search results were managed in Covidence Reference Manager and abstracts were screened by title. Articles relevant to the subject of interest were included and the results are reported narratively. Results Several studies have evaluated the positive impact of enhanced recovery after surgery (ERAS) on length of stay, albeit not on the further impact on 90-day postoperative complication rate, functional recovery, or mortality. Minimally invasive surgery may result in a slighter shorter length of stay compared to open surgery. Physical training combined with nutritional intervention can improve functional recovery up to one year after surgery. Nutritional supplements can preserve muscle and bone mass, and potentially improve recovery. Patient education in stoma care and prevention of infection can significantly improve self-efficacy and avoid symptoms of infection postoperatively. Moreover, specific devices like applications (apps) can support these efforts. Continued smoking increases the risk of developing postoperative complications while no evidence was found on the impact of continued alcohol drinking. Currently, there is no evidence on psychological well-being, sexual health, or shared decision making interventions with an impact on rehabilitation after radical cystectomy. Conclusion Data are scarce but indicate that peri- and postoperative multi-professional interventions can reduce prevalence of sarcopenia, and improve functional recovery, physical capacity, nutritional status, and self-efficacy in stoma care (level 1 evidence). Continued smoking increases the risk of complications, but the effects of a smoking and alcohol intervention remain unclear (level 3 evidence). The results of this review provide guidance for future directions in research and further attempts to develop and test an evidence-based program for follow-up care after radical cystectomy.
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Affiliation(s)
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark and WHO-CC, Clinical Health Promotion Centre, The Parker Institute Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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34
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Yee CH, Yuen-Chun J, Chan ESY. Current evidence for robotic surgery in radical cystectomy. Turk J Urol 2020; 47:S1-S8. [PMID: 32976090 DOI: 10.5152/tud.2020.20355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Robotic-assisted radical cystectomy (RARC) has been gaining momentum as an alternative to its conventional open radical cystectomy (ORC) for the management of invasive bladder cancer. Although RARC, in general, demonstrated less blood loss and shorter hospital stay than ORC, whether there is any significant difference in the overall complication rate still requires further investigation. Thus, both RARC and ORC share a similar oncology outcome, with comparable positive surgical margin rates, disease-free survival, and overall survival. Techniques of intracorporeal urinary diversion (ICUD) have not yet been standardized. ICUD may result in a lower risk of ureteroileal anastomotic stricture than extracorporeal urinary diversion (ECUD). However, ECUD is still a valid and commonly practiced option according to the available data. In general, RARC has been demonstrated to provide promising results. Long-term data and functional outcome after RARC and ICUD are needed to further validate the role of RARC in the management of bladder cancer.
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Affiliation(s)
- Chi Hang Yee
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Jeremy Yuen-Chun
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Eddie Shu-Yin Chan
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
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35
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Presicce F, Leonardo C, Tuderti G, Brassetti A, Mastroianni R, Bove A, Misuraca L, Anceschi U, Ferriero M, Gallucci M, Simone G. Late complications of robot-assisted radical cystectomy with totally intracorporeal urinary diversion. World J Urol 2020; 39:1903-1909. [PMID: 32747981 PMCID: PMC8217047 DOI: 10.1007/s00345-020-03378-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction and objectives To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD). Materials and methods We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy. Results 210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases. Conclusions Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers. Electronic supplementary material The online version of this article (10.1007/s00345-020-03378-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Presicce
- Department of Urology, Sapienza - University of Rome, Via Alessandro Torlonia 12, Rome, Italy.
| | - C Leonardo
- Department of Urology, Sapienza - University of Rome, Via Alessandro Torlonia 12, Rome, Italy
| | - G Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - A Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - R Mastroianni
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - A Bove
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - L Misuraca
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - U Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - M Ferriero
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - M Gallucci
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - G Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
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36
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Clement KD, Pearce E, Gabr AH, Rai BP, Al-Ansari A, Aboumarzouk OM. Perioperative outcomes and safety of robotic vs open cystectomy: a systematic review and meta-analysis of 12,640 cases. World J Urol 2020; 39:1733-1746. [PMID: 32734460 DOI: 10.1007/s00345-020-03385-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Robotic radical cystectomy (RRC) has become a commonly utilised alternative to open radical cystectomy (ORC). We performed a systematic review and meta-analysis of RRC vs ORC focusing on perioperative outcomes and safety. METHODS Medline, EMBASE and CENTRAL were searched from January 2000 to April 2020 following the Preferred Reporting Items for Systematic Review and Meta-analysis Statement for study selection. RESULTS In total, 47 studies (5 randomised controlled trials, 42 non-randomised comparative studies) comprising 12,640 patients (6572 ORC, 6068 RRC) were included. There was no difference in baseline demographics between the groups apart from males were more likely to undergo ORC (OR 0.77, 95% CI 0.69-0.85). Those with muscle-invasive disease were more likely to undergo RRC (OR 1.21, 95% CI 1.09-1.34), and those with high-risk non-muscle-invasive bladder cancer were more likely to undergo ORC (OR 0.80, 95% CI 0.72-0.89). RRC had a significantly longer operating time, less blood loss and lower transfusion rate. There was no difference in lymph node yield, rate of positive surgical margins, or Clavien-Dindo Grade I-II complications between the two groups. However, the RRC group were less likely to experience Clavien-Dindo Grade III-IV (OR 1.56, 95% CI 1.30-1.89) and overall complications (OR 1.45, 95% CI 1.26-1.68) than the ORC group. The mortality rate was higher in ORC although this did not reach statistical significance (OR 1.52, 95% CI 0.99-2.35). CONCLUSION RRC has significantly lower blood loss, transfusion rate and is associated with fewer high grade and overall complications compared to ORC.
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Affiliation(s)
- Keiran D Clement
- Department of Urology, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, UK.
| | - Emily Pearce
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, UK
| | - Ahmed H Gabr
- Department of Urology, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, UK
- Department of Urology, Minia University, Minia, Egypt
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abdulla Al-Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- University of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
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37
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Xie W, Bi J, Wei Q, Han P, Song D, Shi L, Ye D, Shen Y, Gou X, He W, Wang S, Liu Z, Fan J, Wu K, Chen Z, Zhou X, Kong C, Liu Y, Liu C, Xu A, Jin B, Fu G, Xue W, Chen H, Pan T, Tu Z, Lin T, Huang J. Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches. Asian J Urol 2020; 7:291-300. [PMID: 32742929 PMCID: PMC7385523 DOI: 10.1016/j.ajur.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/01/2020] [Accepted: 04/26/2020] [Indexed: 02/08/2023] Open
Abstract
Objective To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy (MIRC) or open radical cystectomy (ORC). Methods We identified patients with bladder cancer who underwent radical cystectomy (RC) in 13 centers of the Chinese Bladder Cancer Consortium (CBCC). Perioperative outcomes were compared between MIRC and ORC. The influence of surgical approaches on overall survival (OS) and cancer-specific survival (CSS) in the entire study group and subgroups classified according to pathologic stage or lymph node (LN) status was assessed with the log-rank test. Multivariable Cox proportional hazard models were used to evaluate the association among OS, CSS and risk factors of interest. Results Of 2 098 patients who underwent RC, 1 243 patients underwent MIRC (1 087 laparoscopic RC and 156 robotic-assisted RC, respectively), while 855 patients underwent ORC. No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate. MIRC was associated with less estimated blood loss, more LN yield, higher rate of neobladder diversion, longer operative time, and longer length of hospital stay. There was no significant difference in OS and CSS according to surgical approaches (p=0.653, and 0.816, respectively). Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS. Conclusions Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.
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Affiliation(s)
- Weibin Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Junming Bi
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongkui Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Shi
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiyang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhiwen Chen
- Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
| | - Xiaozhou Zhou
- Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
| | - Chuize Kong
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Liu
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Abai Xu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanghou Fu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haige Chen
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tiejun Pan
- Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China
| | - Zhong Tu
- Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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38
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Rammant E, Van Wilder L, Van Hemelrijck M, Pauwels NS, Decaestecker K, Van Praet C, Bultijnck R, Ost P, Van Vaerenbergh T, Verhaeghe S, Van Hecke A, Fonteyne V. Health-related quality of life overview after different curative treatment options in muscle-invasive bladder cancer: an umbrella review. Qual Life Res 2020; 29:2887-2910. [PMID: 32504291 DOI: 10.1007/s11136-020-02544-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This umbrella review aims to evaluate the quality, summarize and compare the conclusions of systematic reviews investigating the impact of curative treatment options on health-related quality of life (HRQoL) in muscle-invasive bladder cancer (MIBC). METHODS The Cochrane Library, MEDLINE, Embase and Web of Science were searched independently by two authors from inception until 06 January 2020. Systematic reviews and meta-analyses assessing the impact of any curative treatment option on HRQol in MIBC patients were eligible. Risk of bias was assessed using the AMSTAR 2 tool. RESULTS Thirty-two reviews were included. Robot-assisted RC with extracorporeal urinary diversion and open RC have similar HRQoL (n = 10). Evidence for pelvic organ-sparing RC was too limited (n = 2). Patients with a neobladder showed better overall and physical HRQoL outcomes, but worse urinary function in comparison with ileal conduit (n = 17). Bladder-preserving radiochemotherapy showed slightly better urinary and sexual but worse gastro-intestinal HRQoL outcomes in comparison with RC patients (n = 6). Quality of the reviews was low in more than 50% of the available reviews and most of the studies included in the reviews were nonrandomized studies. CONCLUSION This umbrella review gives a comprehensive overview of the available evidence to date.
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Affiliation(s)
- Elke Rammant
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lisa Van Wilder
- Department of Public Health and Primary Care, University Hospital, Ghent University, Ghent, Belgium
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Nele S Pauwels
- The Knowledge Center for Health Ghent, Ghent University, Ghent, Belgium
| | | | | | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Van Vaerenbergh
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Fonteyne V, Rammant E, Decaestecker K. Predicting perioperative mortality after radical cystectomy: comorbidity assessment tools are only part of the puzzle. Transl Androl Urol 2020; 8:781-784. [PMID: 32038980 DOI: 10.21037/tau.2019.07.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Valérie Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - Elke Rammant
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
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Sighinolfi MC, Micali S, Eissa A, Picozzi SCM, Puliatti S, Rocco B. Robotic assisted radical cystectomy: insights on long term oncological outcomes from the International Robotic Cystectomy Consortium. Transl Androl Urol 2019; 8:S521-S523. [PMID: 32042637 PMCID: PMC6989854 DOI: 10.21037/tau.2019.12.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Moschini M, Stabile A, Mattei A, Montorsi F, Cathelineau X, Sanchez-Salas R. Enhanced recovery after surgery (ERAS) in radical cystectomy patients: from consensus to evidences. Int Braz J Urol 2019; 45:655-657. [PMID: 31397986 PMCID: PMC6837621 DOI: 10.1590/s1677-5538.ibju.2019.04.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Marco Moschini
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.,Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Armando Stabile
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.,Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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42
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Wu Y, Jing J, Wang J, Xu B, Du M, Chen M. Robotic-Assisted Sentinel Lymph Node Mapping With Indocyanine Green in Pelvic Malignancies: A Systematic Review and Meta-Analysis. Front Oncol 2019; 9:585. [PMID: 31312614 PMCID: PMC6614336 DOI: 10.3389/fonc.2019.00585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: Newer technologies such as near-infrared (NIR) imaging of the fluorescent dye indocyanine green (ICG) and daVinci Xi Surgical System have become promising tools for sentinel lymph node (SLN) mapping. This meta-analysis was conducted to comprehensively evaluate the diagnostic value of SLN in assessing lymph nodal metastasis in pelvic malignancies, using ICG with NIR imaging in robotic-assisted surgery. Materials and Methods: A literature search was conducted using PubMed for studies in English before April 2019. The detection rate, sensitivity of SLN detection of metastatic disease, and factors associated with successful mapping (sample size, study design, mean age, mean body mass index, type of cancer) were synthesized for meta-analysis. Results: A total of 17 articles including 1,059 patients were finally included. The reported detection rates of SLN ranged from 76 to 100%, with a pooled average rate of 95% (95% CI: 93-97; 17 studies). The sensitivity of SLN detection of metastatic disease ranged from 50 to 100% and the pooled sensitivity was 86% (95% CI: 75-94; 8 studies). There were no complications related to ICG administration reported. Conclusions: NIR imaging system using ICG in robotic-assisted surgery is a feasible and safe method for SLN mapping. Due to its promising performance, it is considered to be an alternative to a complete pelvic lymph node dissection.
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Affiliation(s)
- Yuqing Wu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.,Surgical Research Center, School of Medicine, Institute of Urology, Southeast University, Nanjing, China
| | - Jibo Jing
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.,Surgical Research Center, School of Medicine, Institute of Urology, Southeast University, Nanjing, China
| | - Jinfeng Wang
- Department of Urology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, Yancheng, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Mulong Du
- Jiangsu Key Laboratory of Cancer Biomarkers, Department of Environmental Genomics, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.,Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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