Can laparoscopic cystectomy become the method of choice in the treatment of invasive urothelial urinary bladder cancer?

BACKGROUND

Radical cystectomy with pelvic lymphadenectomy is the method of choice for muscle-invasive urothelial cell cancer (UCC) treatment and provides the best cancer-specific survival. It can be performed as an open radical cystectomy (ORC), laparoscopic radical cystectomy (LRC) or robot-assisted surgery (RARC).

OBJECTIVES

The aim of this study was to compare laparoscopic and open radical cystectomy in terms of perioperative and oncological results.

MATERIAL AND METHODS

This retrospective study included 260 patients who underwent surgery due to invasive bladder cancer. A laparoscopic radical cystectomy (LRC) was performed on 131 patients and an open radical cystectomy (ORC) on 129 patients. Group was stratified according to the urinary diversion. Oncologic results expressed as perioperative variables were analyzed, adjusted to the type of urinary diversion.

RESULTS

The LRC patients were in worse perioperative condition according to the American Society of Anesthesiologists (ASA) score than the ORC group (3.1 and 2.52, respectively; p = 0.001). The serum protein level was significantly lower in the ORC group, with no difference in body mass index (BMI) between the groups. The median operation time was significantly shorter in the LRC group with ileal conduit and uretero-cutaneostomy than in the same groups operated using open approach (252.5 min and 180 min vs 290 min and 225 min, respectively), as was the hospital discharge time (8.18 days and 11.63 days, respectively; p = 0.004). In both LRC groups, median blood loss was lower, compared with corresponding ORC groups (325 mL and 400 ml vs 800 mL and 1,100 mL, respectively; p < 0.001 in both cases). The level of complications was significantly lower in both LRC groups than in the ORC groups (p < 0.001 and p = 0.001, respectively). The lymph node yield was 12 in the LRC group and 10 in the ORC group. The LRC group had a lower positive surgical margins ratio.

CONCLUSIONS

The laparoscopic approach should be a valid option for radical cystectomy, given the fewer complications, smaller blood loss, and shorter operating and hospitalization times experienced by patients who underwent a laparoscopic cystectomy.

Correlation between malnutrition, body mass index and complications in patients with urinary bladder cancer who underwent radical cystectomy

BACKGROUND

Nutrition is the 3rd most important factor in surgery, following anesthesia and asepsis. Until now, it has been a poorly explored field of urology. The relationship between malnutrition and postoperative complications has been proven beyond doubt in general surgery, where 30% of patients are operated in a malnutrition state.

OBJECTIVES

The aim of our work was to assess the influence of malnutrition, defined by nutritional risk screening (NRS) scale and body mass index (BMI), on postoperative results in patients with bladder cancer after radical cystectomy.

MATERIAL AND METHODS

The research was carried out at 8 urological centers between 2012 and 2014, and included patients with bladder cancer at stage from T2 to T4, who underwent radical cystectomy. The degree of malnutrition was assessed with the aid of the NRS 2002 questionnaire. Other examined parameters were BMI, age, type of operation, and the number of complications, the latter of which were measured by applying the Clavien-Dindo scale.

RESULTS

A total of 125 patients were enrolled in our study, out of whom 64 (51.2%) were undernourished. According to the BMI, most of the patients were overweight - 50 (40%) or had normal body weight - 49 (39.2%); 24 (19.2%) were obese, and 2 (1.6%) were underweight.

CONCLUSIONS

There was no relationship between malnutrition, defined by the NRS scale, and postoperative complications, and we did not find a significant relationship between the other tested variables. We observed only 1 significant relationship between the nutrition state, measured by BMI scale, and the degree in Clavien-Dindo scale. Body mass index under 18.5 and over 30 increased postoperative complications. Nowadays, the recommended scale is NRS 2002, which is based mostly on loss of weight. In our patients, qualitative malnutrition is more probable than quantitative malnutrition.

Resistance patterns of selected respiratory tract pathogens in Poland

This study presents the results of a survey of the in-vitro susceptibility to antimicrobial agents of major pathogens responsible for community-acquired respiratory tract infections in Poland during 2002-2004. The collection of 1184 bacterial isolates comprised 398 Streptococcus pneumoniae, 344 Haemophilus influenzae, 302 Streptococcus pyogenes and 140 Moraxella catarrhalis. Among the pneumococcal isolates, 16.8% were penicillin-non-susceptible (PNSP), of which 80.6% were identified as multidrug-resistant. Overall, 9.0% of H. influenzae isolates were beta-lactamase-positive, although this percentage increased noticeably in the third year of the study. Based on PCR results, 12.8% of H. influenzae isolates were identified as low-level beta-lactamase-negative, ampicillin-resistant (BLNAR), and one isolate as low-level beta-lactamase-positive, amoxycillin-clavulanic acid-resistant (BLPACR). Pulsed-field gel electrophoresis (PFGE) classified 45 H. influenzae isolates with altered penicillin-binding proteins into 15 PFGE types, including two predominant types (with four and six sub-types) containing 15 and ten isolates, respectively. Resistance to tetracycline, erythromycin and clindamycin was found in 20.9%, 8.9% and 4.6% of S. pyogenes isolates, respectively. The production of beta-lactamase characterised 91.4% of M. catarrhalis isolates. In summary, the overall occurrence of PNSP in Poland remains stable, although there was a noticeable increase in the proportion of fully-resistant isolates. A rising trend in the prevalence of beta-lactamase producers and low-level BLNAR isolates was observed among Polish isolates of H. influenzae.

Characterisation of Neisseria meningitidis C:2b:P1.2,5 isolates in Poland

This study aimed to characterise Neisseria meningitidis C:2b:P1.2,5 isolates from Poland, which have now become predominant among serogroup C isolates in this country. Overall, 44 isolates (25 invasive and 19 from contact carriers) were typed by whole-cell ELISA and pulsed-field gel electrophoresis. Additionally, the invasive isolates were analysed by multilocus sequence typing, which revealed that they all belonged to the ST-8 complex/cluster A4. The emergence of this clone in other countries has resulted in mass immunisation campaigns and has been associated with a higher level of decreased susceptibility to penicillin; however the present study detected only one isolate that was penicillin-non-susceptible.