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Ali D, Sawhney R, Billah MS, Harrison R, Stifelman M, Lovallo G, Gopal N, Zaifman J, Ahsanuddin S, Lama-Tamang T, Koster H, Ahmed M. Single-Port Robotic Radical Cystectomy with Intracorporeal Bowel Diversion: Initial Experience and Review of Surgical Outcomes. J Endourol 2021; 36:216-223. [PMID: 34605663 DOI: 10.1089/end.2021.0287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION & OBJECTIVE Scant literature is available on surgical outcomes of radical cystectomies on the new single-port (SP) system. This study compares short term outcomes in patients undergoing radical cystectomy with intracorporeal urinary diversion (ICUD) on the multi-port (MP) vs. SP platform. METHODS This IRB approved study used a prospective cystectomy database and non-parametric testing including Chi-Squared, Mann-Whitney U, and Fisher Exact tests to analyze all variables stratified by surgical approach. RESULTS 34 patients underwent radical cystectomy with ICUD from 9/1/2019 to 2/8/2021. 20 patients were in the MP cohort, while 14 were in the SP group. Table 1 presents the demographics of both groups and shows no statistically significant differences. Intra- and post-operative as well as pathology data is shown in Table 2. Patients in the SP group had less narcotic use (MP: 25 MME vs. SP: 11.5 MME, p=0.047) and shorter return of bowel function (MP: 3 days vs. SP: 2 days, p=0.032). Operative times were similar between both groups despite having fewer patients undergoing ileal conduit (MP: 85% vs. SP: 50%, p=0.027) in the SP group. In table 3, we list the early short term post-operative follow up data for each group which showed no significant differences between the two groups with an average follow up of 4.9 months for MP and 4.4 months for SP. CONCLUSIONS Our initial experience with SP robotic cystectomy and ICUD appears to be safe and an effective alternative to MP cystectomies. A learning curve was involved but the overall transition from MP to SP was smooth. Operative times were similar despite fewer patients undergoing ileal diversion, shorter return of bowel function, and less narcotic use in the SP group. Further studies including longer follow ups with multi-institutional data are underway.
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Affiliation(s)
- David Ali
- Rutgers New Jersey Medical School, 12286, Urology, Newark, New Jersey, United States;
| | - Rohan Sawhney
- Rutgers New Jersey Medical School, 12286, Urology, Newark, New Jersey, United States;
| | - Mubashir Shabil Billah
- Rutgers New Jersey Medical School, 12286, Urology, 185 S Orange Ave, Newark, Newark, New Jersey, United States, 07103-2714;
| | - Robert Harrison
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States;
| | - Michael Stifelman
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States.,Hackensack Meridian School of Medicine, 576909, Nutley, New Jersey, United States;
| | - Gregory Lovallo
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States.,Hackensack Meridian School of Medicine, 576909, Nutley, New Jersey, United States;
| | - Nikhil Gopal
- New York Medical College School of Medicine, 200540, Valhalla, New York, United States;
| | - Jay Zaifman
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States;
| | - Salma Ahsanuddin
- Rutgers New Jersey Medical School, 12286, Urology, Newark, New Jersey, United States;
| | - Tenzin Lama-Tamang
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States;
| | - Helaine Koster
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States;
| | - Mutahar Ahmed
- Hackensack University Medical Center, 3673, Hackensack, New Jersey, United States.,Hackensack Meridian School of Medicine, 576909, Nutley, New Jersey, United States;
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Wei H, Gao J, Wang M, Wasilijiang W, Ai P, Zhou X, Cui L, Song L, Wu A, Xing N, Niu Y. Impact of preoperative body mass index on perioperative outcomes is optimized by enhanced recovery protocols in laparoscopic radical cystectomy with intracorporeal urinary diversion. Transl Androl Urol 2021; 10:2008-2018. [PMID: 34159081 PMCID: PMC8185665 DOI: 10.21037/tau-21-171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background We aimed to examine whether body mass index (BMI) had an impact on clinical outcomes of laparoscopic radical cystectomy with intracorporeal urinary diversion. Furthermore, we analyzed the optimization of enhanced recovery protocols (ERPs) on the impact of BMI on clinical outcomes. Methods By searching our database, data of 83 consecutive patients were retrospectively collected, including 37 patients with a BMI <24 kg/m2 (group A) and 46 patients with a BMI ≥24 kg/m2 (group B). The baseline and peri-operative variables of the two groups were compared. Subgroup analysis was conducted for ERPs (11 patients in group A1, 18 patients in group B1) and conventional recovery protocols (CRPs; 26 patients in group A2, 28 patients in group B2). The primary outcomes were 30-day overall complication rate and ΔALBmin (reduction proportion of minimum albumin). The secondary outcomes were operative time and length of stay. Results The baseline variables were similar between the two groups (P>0.05). The 30-day overall complication rate, operative time, and length of stay were similar between the two groups (P>0.05). But post-operative nausea and vomiting (PONV) was higher in group A than in group B (32.4% vs. 8.7%, P=0.014). Group A was associated with lower serum albumin level pre-operatively and on post-operative days 1–3. ΔALBmin was higher in group A than in group B (33.08%±9.88% vs. 27.92%±8.52%, P<0.05). In the subgroup analysis, the CRPs group presented similar results, with group A2 showing higher PONV rate, lower albumin level pre- and post-operatively, and higher level of reduction proportion (P<0.05). For the ERPs group, the PONV rate, pre-operative albumin level, and reduction proportion were similar between group A1 and B1 (P>0.05). Multivariable analysis showed that PONV and CRPs were independently associated with ΔALBmin ≥34% (P<0.05). Conclusions BMI had no impact on the 30-day overall complication rate, operative time, and length of stay of patients who underwent laparoscopic radical cystectomy with intracorporeal urinary diversion. BMI <24 kg/m2 was associated with higher PONV rate and more albumin loss, both of which could be optimized by ERPs.
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Affiliation(s)
- Houyi Wei
- Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiandong Gao
- Department of Anaesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mingshuai Wang
- Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wahafu Wasilijiang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pan Ai
- Department of Anaesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Zhou
- Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liyan Cui
- Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liming Song
- Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Anshi Wu
- Department of Anaesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinong Niu
- Institute of Urology, Capital Medical University, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Lu Y, Tao J. Diabetes Mellitus and Obesity as Risk Factors for Bladder Cancer Prognosis: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:699732. [PMID: 34690923 PMCID: PMC8529220 DOI: 10.3389/fendo.2021.699732] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/14/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Urinary bladder carcinoma is common in developed settings, and prognosis may be impacted by lifestyle factors such as excess body weight and diabetes mellitus. The present meta-analysis aimed to systematically collate and analyze evidence on the impact of diabetes and excess BMI on bladder cancer outcomes. METHODS PubMed, Scopus, and Google Scholar databases were screened for relevant studies that examined the association between bladder cancer outcomes and diabetes and/or excess body weight. The primary outcomes for this study were mortality (both all-cause and cancer-specific), risk of cancer progression, and recurrence. Strength of association was presented in the form of pooled adjusted hazard ratios (HR). Statistical analysis was performed using STATA version 16.0. RESULTS Twenty-five articles met inclusion criteria. Nine of these examined diabetes mellitus while 16 studied body mass index. All studies were retrospective. Diabetic patients had significantly higher risk for all-cause mortality (HR 1.24, 95% CI: 1.07, 1.44, n=3), cancer specific mortality (HR 1.67, 95% CI: 1.29, 2.16, n=7), disease progression (HR 1.54, 95% CI: 1.15, 2.06, n=8), and recurrence (HR 1.40, 95% CI: 1.32, 1.48, n=8) compared to non-diabetics. No statistically significant risk change for all-cause mortality, cancer specific mortality, disease progression, and recurrence was found for overweight patients. However, obese individuals were at higher risk for disease progression (HR 1.88, 95% CI: 1.41, 2.50, n=3) and recurrence (HR 1.60, 95% CI: 1.06, 2.40, n=7) compared to normal BMI patients. CONCLUSIONS These findings suggest that diabetes and excess body weight negatively influences bladder cancer prognosis and outcome. The increased risk of mortality due to diabetes was similar to that in the general population. Since retrospective studies are potentially susceptible to bias, future prospective studies on this subject are required.
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