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Piramide F, Turri F, Amparore D, Fallara G, De Groote R, Knipper S, Wuernschimmel C, Bravi CA, Lambert E, Di Maida F, Liakos N, Pellegrino F, Andras I, Mastrorosa A, Tillu N, Mastroianni R, Paciotti M, Wenzel M, Bianchi R, di Trapani E, Moschovas MC, Gandaglia G, Moschini M, D'Hondt F, Rocco B, Fiori C, Galfano A, Minervini A, Simone G, Briganti A, De Cobelli O, Gaston R, Montorsi F, Breda A, Wiklund P, Porpiglia F, Mottrie A, Larcher A, Dell'Oglio P. Atlas of Intracorporeal Orthotopic Neobladder Techniques After Robot-assisted Radical Cystectomy and Systematic Review of Clinical Outcomes. Eur Urol 2024; 85:348-360. [PMID: 38044179 DOI: 10.1016/j.eururo.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple and heterogeneous techniques have been described for orthotopic neobladder (ONB) reconstruction after robot-assisted radical cystectomy. Nonetheless, a systematic assessment of all the available options is lacking. OBJECTIVE To provide the first comprehensive step-by-step description of all the available techniques for robotic intracorporeal ONB together with individual intraoperative, perioperative and functional outcomes based on a systematic review of the literature. DESIGN, SETTING, AND PARTICIPANTS We performed a systematic review of the literature, and MEDLINE/PubMed, Embase, Scopus, and Web of Science databases were searched to identify original articles describing different robotic intracorporeal ONB techniques and reporting intra- and perioperative outcomes. Studies were categorized according to ONB type, providing a synthesis of the current evidence. Video material was provided by experts in the field to illustrate the surgical technique of each intracorporeal ONB. SURGICAL PROCEDURE Nine different ONB types were identified: Studer, Hautmann, Y shape, U shape, Bordeaux, Pyramid, Shell, Florence Robotic Intracorporeal Neobladder, and Padua Ileal Neobladder. MEASUREMENTS Continuous and categorical variables are presented as mean ± standard deviation and as frequencies and proportions, respectively. RESULTS AND LIMITATIONS Of 2587 studies identified, 19 met our inclusion criteria. No cohort studies or randomized control trials comparing different neobladder types are available. Available techniques for intracorporeal robotic ONB reconstruction have similar operative time, estimated blood loss, intraoperative complications, and length of stay. Major variability exists concerning postoperative complications and functional outcomes, likely related to reporting bias. CONCLUSIONS Several techniques are described for intracorporeal ONB during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted ONB reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. PATIENT SUMMARY Patients elected for radical cystectomy should be aware that multiple techniques for robotic orthotopic neobladder are available, but that current evidence does not favor one type over the others.
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Affiliation(s)
- Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Fallara
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Sophie Knipper
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Edward Lambert
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Nikolaos Liakos
- Department of Urology, Medical Faculty and Medical Centre of the University of Freiburg, Freiburg, Germany
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandro Mastrorosa
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France; Urology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Neeraja Tillu
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco Paciotti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Bernando Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Breda
- Department of Urology, Universitat Autònoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Porserud A, Karlsson P, Nygren-Bonnier M, Aly M, Hagströmer M. The feasibility of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer, prior to the CanMoRe trial. Pilot Feasibility Stud 2024; 10:12. [PMID: 38254174 PMCID: PMC10802056 DOI: 10.1186/s40814-024-01443-1] [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: 08/04/2021] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Complications after radical cystectomy for urinary bladder cancer are common. Physical activity after surgery is thought to reduce complications. However, patients with urinary bladder cancer have low levels of physical activity, and interventions supporting physical exercise are needed. This study aimed to evaluate the feasibility of a physical exercise intervention in primary health care. One of the aims of the larger clinical trial will be to reduce complications. METHODS Patients with urinary bladder cancer and who were scheduled for a robotic-assisted radical cystectomy were recruited from Karolinska University Hospital, between February and May 2019. The patients had to be mobile, understand Swedish, and live in Stockholm. The exercise programme was conducted at one primary health care setting over 12 weeks. The exercise programme included supervised aerobic and strengthening exercises, which were performed twice a week, as well as daily walks. Feasibility was measured with process feasibility, including eligibility criteria, adherence, and acceptability, and scientific feasibility, including the ability of outcomes to indicate change, safety, and progression in the exercise programme. RESULTS Ten patients with a median age of 70 years (min 53-max 86) were included. Adherence to all parts of the intervention was not feasible because of patients' postoperative complications, resulting in dropouts. For the patients who took part in the exercise programme, adherence and acceptability for the exercise period were feasible, but the 6-min walk test was not feasible at discharge from the hospital. Physiotherapists in the primary health care setting perceived the process as feasible. Moreover, the ability of outcomes to indicate change and progression in the exercise programme was feasible, meanwhile no adverse events were registered. CONCLUSIONS The exercise intervention was feasible for the patients that took part in the exercise programme, with respect to safety and progression through the exercise programme. Furthermore, this study suggests that some improvements needed to be implemented in the process, prior to the upcoming randomised controlled trial.
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Affiliation(s)
- Andrea Porserud
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden.
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Patrik Karlsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden
- Patient Area Pelvic Cancer, Cancer Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Academic Primary Health Care Centre, 113 65, Stockholm, Region Stockholm, Sweden
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Morra S, Scheipner L, Baudo A, Jannello LMI, de Angelis M, Siech C, Goyal JA, Touma N, Tian Z, Saad F, Califano G, Creta M, Celentano G, Shariat SF, Ahyai S, Carmignani L, de Cobelli O, Musi G, Briganti A, Chun FKH, Longo N, Karakiewicz PI. The Association between Urinary Diversion Type and Other-Cause Mortality in Radical Cystectomy Patients. Cancers (Basel) 2024; 16:429. [PMID: 38275870 PMCID: PMC10813972 DOI: 10.3390/cancers16020429] [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: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND It is unknown whether more complex UD, such as orthotopic neobladder and abdominal pouch, may be associated with higher OCM rates than ileal conduit. We addressed this knowledge gap within the SEER database 2004-2020. METHODS All T1-T4aN0M0 radical cystectomy (RC) patients were identified. After 1:1 propensity score matching (PSM), cumulative incidence plots, univariable and multivariable competing-risks regression (CRR) models were used to test differences in OCM rates according to UD type (orthotopic neobladder vs. abdominal pouch vs. ileal conduit). RESULTS Of all 3008 RC patients, 2380 (79%) underwent ileal conduit vs. 628 (21%) who underwent continent UD (268 orthotopic neobladder and 360 abdominal pouch). After PSM relative to ileal conduit, neither continent UD (13 vs. 15%; p = 0.1) nor orthotopic neobladder (13 vs. 16%; p = 0.4) nor abdominal pouch (13 vs. 15%; p = 0.2) were associated with higher 10-year OCM rates. After PSM and after adjustment for cancer-specific mortality (CSM), as well as after multivariable adjustments relative to ileal conduit, neither continent UD (Hazard Ratio [HR]:0.73; p = 0.1), nor orthotopic neobladder (HR:0.84; p = 0.5) nor abdominal pouch (HR:0.77; p = 0.2) were associated with higher OCM. CONCLUSIONS It appears that more complex UD types, such as orthotopic neobladder and abdominal pouch are not associated with higher OCM relative to ileal conduit.
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Affiliation(s)
- Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
| | - Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, Medical University of Graz, 8010 Graz, Austria;
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy;
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.)
- Department of Urology, Università degli Studi di Milano, 20126 Milan, Italy
| | - Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany;
| | - Jordan A. Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
| | - Nawar Touma
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
| | - Gianluigi Califano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
| | - Massimiliano Creta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
| | - Giuseppe Celentano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, 8010 Graz, Austria;
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy;
- Department of Urology, IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.)
- Department of Oncology and Haemato-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.)
- Department of Oncology and Haemato-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany;
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
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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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Vrang ML, Østergren PB, Fode MM, Vangedal M, Lam GW. Robot-assisted radical cystectomy with intracorporeal urinary diversion: a Danish 11-year series. BJU Int 2023; 132:428-434. [PMID: 37395155 DOI: 10.1111/bju.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To evaluate the oncological and perioperative outcomes from a large, single-centre, robot-assisted radical cystectomy (RARC) cohort performed with intracorporeal urinary diversion (ICUD). PATIENTS AND METHODS Patients who underwent RARC because of bladder cancer or recurrent carcinoma in situ from June 2009 until August 2020 at Herlev and Gentofte Hospital were prospectively and consecutively included. Kaplan-Meier survival analysis was used to estimate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). A Cox proportional hazards model was used to identify individual predictors of outcomes. Multiple logistic regression analysis was used to identify predictors of high-grade complications (Clavien-Dindo Grade ≥III). RESULTS A total of 542 patients were included. The median (interquartile range) follow-up was 5.3 (2.73-8.06) years. In all, 78 patients (14%) were converted to open surgery; 15 (3%) during cystectomy and 63 patients (12%) were converted from ICUD to extracorporeal urinary diversion. The 5-year RFS, CSS and OS rates were 63% (95% confidence interval [CI] 59%-68%), 75% (95% CI 72%-80%) and 67% (95% CI 63%-72%), respectively. Pathological non-organ-confined disease (tumour stage >T2 or positive lymph nodes) predicted poorer RFS, CSS and OS. Reconstruction with a neobladder (20% of cases) compared to an ileal conduit was the only predictor of high-grade complications (odds ratio 2.54, 95% CI 1.46-4.43; P < 0.001). CONCLUSION A RARC with ICUD is feasible as a standard surgical procedure for bladder cancer with only a few patients converted to open surgery. In our hands reconstruction with a neobladder was a strong predictor for high-grade complications.
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Affiliation(s)
- Marie-Louise Vrang
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Michael Vangedal
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Gitte Wrist Lam
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark
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6
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Les complications en chirurgie urologique. Recueil et classification. Prog Urol 2022; 32:906-918. [DOI: 10.1016/j.purol.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
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Chen Z, He P, Zhou X, Li P, Li Q, Zheng J, Li X, Zhou Z. Preliminary Functional Outcome Following Robotic Intracorporeal Orthotopic Ileal Neobladder Suspension with Round Ligaments in Women with Bladder Cancer. Eur Urol 2021; 82:295-302. [PMID: 34862097 DOI: 10.1016/j.eururo.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic urinary retention (CUR) is a frequent complication after orthotopic neobladder (ONB) reconstruction in women. To decrease CUR, several open surgical modifications to provide back support to the ONB have been established on the basis of pelvic anatomical differences between females and males. OBJECTIVE To illustrate our technique for robotic intracorporeal reconfiguration of ONB as integrated into our open surgical approach to provide back support to the ONB with round ligaments in women. DESIGN, SETTING, AND PARTICIPANTS From November 2017 to April 2021, 28 patients underwent robotic intracorporeal ONB with a minimum of 6 mo of follow-up at a single centre. SURGICAL PROCEDURE We performed robotic radical cystectomy, pelvic lymphadenectomy, and a complete intracorporeal ONB suspended with round ligaments (rONB). Our surgical procedure is demonstrated in the accompanying video. MEASUREMENTS Demographics and clinical and pathological data were collected. Perioperative and 90-d complications and 6-mo functional outcomes were compared for the rONB group (n = 12) and the patients receiving a traditional ONB (tONB; n = 16). RESULTS AND LIMITATIONS The median total operative time was 305 min (interquartile range [IQR] 270-370) for tONB and 303 min (IQR 287-330) for rONB. The median estimated blood loss was 325 ml (IQR 200-700) for tONB and 350 ml (IQR 262-600) for rONB. Some 50% of the tONB group and 41.7% of the rONB group experienced low-grade complications. A total of 12.5% tONB and 8.3% rONB patients experienced high-grade complications with neobladder-vaginal fistula. The cumulative risk of CUR was 37.5% in the tONB group and 16.7% in the rONB group. This study is limited by the small sample size and the short follow-up period. CONCLUSIONS We established a feasible surgical technique for a robotic intracorporeal ONB configuration suspended with round ligaments. This may prevent the occurrence of emptying dysfunction in women. PATIENT SUMMARY We describe our stepwise technique for creating a new bladder within the body that is suspended with round ligaments. Patients undergoing removal of the bladder for bladder cancer may benefit from this technique in terms of better urinary function and the advantages of a robotic surgical approach.
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Affiliation(s)
- Zhiwen Chen
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Peng He
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaozhou Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Peng Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qianwei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ji Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xuemei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhansong Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
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Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months? Curr Opin Urol 2021; 31:556-561. [PMID: 34265842 DOI: 10.1097/mou.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Urinary diversion (UD) with or without cystectomy is a procedure with high short term complication rates. In this review, we summarize the most relevant findings of the last 2 years. RECENT FINDINGS The use of a prophylactic mesh decreases the risk of parastomal hernia after ileal conduit (IC) surgery without adding mesh-related complications according to a recent randomized multicentre trial. Robot-assisted surgery is increasingly applied for UD and is evolving from extra- to intra-corporeal reconstruction in both continent and incontinent diversions, but there is still a need for appropriately designed studies assessing both short- and long-term complications. Promising techniques to decrease ureterointestinal stricture rates have been reported from small series, such as retrosigmoid placement of the proximal IC to avoid transpositioning of the left ureter, or in robot-assisted surgery the use of indocyanine green with near-infrared light to improve visualisation of distal ureteral viability. SUMMARY Most recent reports derive from observational data. Appropriate randomized studies are warranted for the evaluation of new techniques to be implemented in a surgical area that still is associated with high complication rates.
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Robot assisted radical cystectomy with Florence robotic intracorporeal neobladder (FloRIN): Analysis of survival and functional outcomes after first 100 consecutive patients upon accomplishment of phase 3 IDEAL framework. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2651-2657. [PMID: 34023169 DOI: 10.1016/j.ejso.2021.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Aim of the study was to evaluate the Florence intracorporeal neobladder (FloRIN) oncological and functional outcomes at the end of assessment phase (phase 3) IDEAL-Guidelines. MATERIALS AND METHODS This single-institution prospective series included consecutive patients treated with robot-assisted radical cystectomy (RARC) and FloRIN reconfiguration technique from February 2016 to June 2020. Functional features were evaluated six months after surgery. Patients were grouped into four quartiles according to time of radical cystectomy and impact of learning curve improvement was evaluated. RESULTS One-hundred FloRIN were completed with a median console time of 373 (IQR: 312-415) minutes. Two cases were converted to open surgery. No intraoperative complications occurred. At pathological examination, 30% of patients were staged as pT ≤ 1 and 47% as pT ≥ 3. Transitional cell carcinoma was present in 87% of cases. Carcinoma in situ (CIS) and nodal involvement were observed in 38% and 29% of patients, respectively. At a median follow-up time of 17 (IQR: 7-28) months, 20 clinically relevant events (Clavien-Dindo≥3) occurred. Operative time significantly decreased throughout the series (median minutes 435; 395; 365 and 330 in the four quartiles, respectively; p < 0.001). Similarly, early Clavien-Dindo≥3 postoperative complications rate significantly decreased across the series (number of events: 1; 4; 0; 0; p = 0.03). Overall, 75% and 65% of patients achieved day-time and nigh-time continence, respectively. Twenty-seven patients experienced disease recurrence. Cancer-specific and overall survival were equal to 80%. CONCLUSIONS RARC with FloRIN reconfiguration showed worthy functional and survival outcomes, with learning curve improvement significantly influencing operative time and early complications rate across series.
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Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics. J Clin Med 2021; 10:jcm10091812. [PMID: 33919290 PMCID: PMC8122613 DOI: 10.3390/jcm10091812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Introduction: The advent of robotic surgery led to the assumption that laparoscopic surgery would be replaced entirely. However, the high costs of robotic surgery limit its availability. The aim of the current study was to assess the feasibility of the 3D laparoscopic approach for the most complex urological procedures. (2) Materials and methods: We included in the current study all patients who had undergone complex 3D laparoscopic procedures in our department since January 2017, including radical nephrectomy (LRN) using a dual combined approach (19 patients), radical nephroureterectomy (LRNU) with bladder cuff excision (13 patients), and radical cystectomy (LRC) with intracorporeal urinary diversion (ICUD) (21 patients). (3) Results: The mean operative time was 345/230/478 min, the complications rate was 26%/30.76%/23.8% and positive surgical margins were encountered in 3/1/1 patients for the combined approach of LRN/LRNU/LRC with ICUD, respectively. A single patient was converted to open surgery during LRN due to extension of the vena cava thrombus above the hepatic veins. After LRC, sepsis was the most common complication and 8 patients were readmitted at a mean of 15.5 days after discharge. (4) Conclusions: In the era of robotic surgery, laparoscopy remains a plausible alternative for most complex oncological cases.
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Su X, Wu K, Wang S, Su W, Li C, Li B, Mao X. The impact of orthotopic neobladder vs ileal conduit urinary diversion after cystectomy on the survival outcomes in patients with bladder cancer: A propensity score matched analysis. Cancer Med 2020; 9:7590-7600. [PMID: 32869540 PMCID: PMC7571812 DOI: 10.1002/cam4.3404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/01/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bladder cancer (BCa) is the most common urinary malignancy. The standard surgical treatment for patients with muscle-invasive BCa is cystectomy plus urinary diversion. Ileal conduit (IC) or orthotopic neobladder (ON), which have different indications, are the most commonly performed urinary diversions. METHODS AND MATERIALS We sampled 5480 BCa patients from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Kaplan-Meier method with the log-rank test was used to assess cancer-specific survival (CSS) and overall survival (OS). Univariate and multivariate Cox's proportional hazard model was conducted to evaluate the hazard ratio of cancer-specific mortality and all-cause mortality before and after propensity score matching (PSM). RESULTS We identified 5480 patients who received radical cystectomy (RC) plus IC (n = 5071) or ON (n = 409) with a median follow-up period of 33 months (interquartile range, 13-78 months). Patients in the ON group tended to be male and younger, with a higher percentage of married individuals, early pathological T stage, lymphadenectomy, and non-radiotherapy (all P < .05). After 1:1 PSM, 409 matched pairs were selected. Univariate and multivariate analysis showed that the ON group had better CSS and OS probabilities than the IC group in the overall cohort [hazard ratio (HR): 0.692, 95% confidence intervals (CI): 0.576-0.831, P < .001; HR: 0.677, 95% CI: 0.579-0.793, P < .001 respectively]. However, subgroup analysis revealed that only patients with pathological T2 stage benefited from ON diversion after PSM in the context of CSS (P = .016) and OS (P <.001). CONCLUSIONS Young, married, and male patients with early pathological T stage, especially T2 stage, were more suitable to receive RC plus ON surgery, which could improve their probability of survival.
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Affiliation(s)
- Xiaohong Su
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kaihui Wu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuo Wang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Su
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuanyin Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bingkun Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangming Mao
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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12
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Anceschi U, Brassetti A, Tuderti G, Ferriero MC, Costantini M, Bove AM, Calabrò F, Carlini P, Vari S, Mastroianni R, Gallucci M, Simone G. Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience. J Clin Med 2020; 9:E2736. [PMID: 32847113 PMCID: PMC7564756 DOI: 10.3390/jcm9092736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Response to neoadjuvant chemotherapy (NACT) has been proven to be an established prognostic factor after open radical cystectomy (ORC). We evaluated the impact of NACT on survival outcomes of a single-institution robotic radical cystectomy (RARC) series. METHODS From January 2012 to June 2020, 79 patients were identified. Baseline, demographic, perioperative, and pathologic data were described. Kaplan-Meier with the log-rank test was used to compare overall survival (OS) differences between complete, partial, and no-NACT responders, respectively. Univariable and multivariable regression analyses were performed to identify predictors of OS. RESULTS Complete, partial, and absent response to NACT were recorded in 43 (54.4%), 21 (19%), and 15 (26.6%) patients, respectively. A complete response to NACT displayed a trend toward significant higher OS (p = 0.03). In univariable analysis, significant predictors of lower OS were hypertension (HR 3.37; CI 95% 1.31-8.62; p = 0.01); advanced nodal involvement (HR 2.41; CI 95% 0.53-10.9; p < 0.001); and incomplete response to NACT (HR 0.41; CI 95% 0.18-0.95; p = 0.039). In multivariable analysis, the only independent predictor of worse OS was advanced pathologic N stages (HR 10.1; CI: 95% CI 2.3-44.3; p = 0.002). CONCLUSIONS Complete response to NACT is associated with increased OS probability, but significant nodal residual disease remains the only independent predictor of OS after RARC.
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Affiliation(s)
- Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
| | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
| | - Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
| | - Maria Consiglia Ferriero
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
| | - Manuela Costantini
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
| | - Fabio Calabrò
- Department of Oncology, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy;
| | - Paolo Carlini
- Department of Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (P.C.); (S.V.)
| | - Sabrina Vari
- Department of Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (P.C.); (S.V.)
| | - Riccardo Mastroianni
- Department of Urology, La Sapienza—University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.M.); (M.G.)
| | - Michele Gallucci
- Department of Urology, La Sapienza—University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.M.); (M.G.)
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (G.T.); (M.C.F.); (M.C.); (A.M.B.); (G.S.)
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