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International Journal of Urology :... Mar 2018In 2018, robot-assisted radical cystectomy will enter its 15th year. In an era where an effort is being made to standardize complication reporting and videos of the... (Comparative Study)
Comparative Study Review
In 2018, robot-assisted radical cystectomy will enter its 15th year. In an era where an effort is being made to standardize complication reporting and videos of the procedure are readily available, it is inevitable and justified that like everything novel, robot-assisted radical cystectomy should be scrutinized against the gold standard, open radical cystectomy. The present comparison is focused on several parameters: oncological, functional and complication outcomes, and direct and indirect costs. Meta-analysis and prospective randomized trials comparing robot-assisted radical cystectomy versus open radical cystectomy have been published, showing an oncological equivalence and in some cases an advantage of robot-assisted radical cystectomy in terms of postoperative morbidity. In the present review, we attempt to update the available knowledge on this debate and discuss the limitations of the current evidence that prevent us from drawing safe conclusions.
Topics: Cystectomy; Humans; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 29178344
DOI: 10.1111/iju.13497 -
Urologia Internationalis 2023This study aimed to compare the survival outcomes between trimodal therapy (TT) and partial cystectomy (PC) in muscle-invasive bladder cancer (MIBC) patients.
OBJECTIVE
This study aimed to compare the survival outcomes between trimodal therapy (TT) and partial cystectomy (PC) in muscle-invasive bladder cancer (MIBC) patients.
METHODS
The data of 13,096 patients with MIBC diagnosed between 2004 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. Among them, 4,041 patients underwent TT and 1,670 patients underwent PC. Propensity score matching was performed to balance the characteristics between the 2 treatment groups. A multivariate Cox regression analysis model and a competing risk model were used to evaluate overall survival (OS) and cancer-specific survival. Cumulative incidence survival curves were obtained using the Kaplan-Meier method.
RESULTS
Results of multivariate Cox analysis before propensity score matching showed that the TT group had a 31% reduction in cause-specific survival relative to the PC group (HR: 0.69, 95% CI: 0.61-0.78, p < 0.001) and a 28% reduction in OS (HR: 0.72, 95% CI: 0.66-0.79, p < 0.001). After propensity score matching, the 2 groups yielded 972 patients, with 3-year cause-specific survival rates of 54.1% and 68.5% in the TT group and the PC group, respectively.
CONCLUSIONS
Patients who underwent PC had a better prognosis than those who received TT. In addition, for MIBC patients who required bladder-sparing therapy, advanced age (≥80 years), pathological type of squamous cell carcinoma, and tumor stage of T3-4, N2-3, and M1 were independent poor prognostic factors.
Topics: Humans; Aged, 80 and over; Urinary Bladder; Cystectomy; Chemoradiotherapy; Urinary Bladder Neoplasms; Prognosis; Muscles; Neoplasm Invasiveness; Treatment Outcome
PubMed: 34818263
DOI: 10.1159/000518562 -
Der Urologe. Ausg. A Apr 2015In many cases radical cystectomy is not feasible in patients suffering from muscle-invasive bladder cancer due to advanced age of the patient or limiting comorbidities... (Review)
Review
BACKGROUND
In many cases radical cystectomy is not feasible in patients suffering from muscle-invasive bladder cancer due to advanced age of the patient or limiting comorbidities which increase the perioperative risk. A further group of patients decline radical cystectomy due to potential postoperative complications and the resulting impairment in the quality of life.
OBJECTIVES
This article provides an overview of alternative therapeutic concepts to radical cystectomy in muscle-invasive bladder cancer.
MATERIAL AND METHODS
The study involved a database analysis and gives a discussion of clinical trials concerning alternative therapeutic concepts for muscle-invasive bladder cancer treatment strategies.
RESULTS
Transurethral resection, open partial cystectomy, radiotherapy, chemotherapy and combined therapeutic regimens are available as alternatives to radical cystectomy.
CONCLUSION
Radical cystectomy is the accepted standard of care in the treatment of muscle-invasive bladder cancer but in selected patients, established alternative methods can also be offered. A comprehensive patient information and counseling is therefore necessary to find the best therapeutic option in each individual case. Salvage cystectomy is a therapeutic option in cases of failure of organ-preserving treatment.
Topics: Chemoradiotherapy; Combined Modality Therapy; Cystectomy; Evidence-Based Medicine; Humans; Muscle Neoplasms; Neoplasm Invasiveness; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 25895563
DOI: 10.1007/s00120-015-3775-6 -
The International Journal of Medical... Aug 2022To report our contemporary experience with robotic-assisted partial cystectomy (RAPC) for muscle invasive bladder cancer.
OBJECTIVE
To report our contemporary experience with robotic-assisted partial cystectomy (RAPC) for muscle invasive bladder cancer.
METHODS
This is a retrospective review of patients who underwent robotic-assisted partial cystectomy with us between 2013 and 2020 and provided ≥12 months of follow up.
RESULTS AND LIMITATIONS
The median operative time for our 35 patients was 190 min (Interquartile range [IQR] 155-280). Four patients developed grade 3 or higher complications (ileus, pneumonia, and urethral stricture). At 12 months follow-up, the median IPSS score was 10 (IQR 7-11), and recurrence happened in seven patients (recurrence-free survival 80%). Five of the patients who developed recurrence died because of their disease, and two other patients died of causes unrelated to their cancer.
CONCLUSIONS
We describe our technique, functional outcomes, and short-term follow up results in highly selected patients with muscle-invasive bladder cancer treated with RAPC.
Topics: Cystectomy; Humans; Muscles; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 35262267
DOI: 10.1002/rcs.2390 -
BJU International Jan 2017To report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological...
OBJECTIVE
To report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological variables, as well as the overall oncological efficacy of this approach.
PATIENTS AND METHODS
We retrospectively reviewed all patients who underwent RAPC by a single surgeon between 2005 and 2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumour. Clinicopathological data and perioperative variables were recorded. Continuous variables were compared using the Student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intra-diverticular neoplasms was done using univariate logistic regression. Survival was estimated using the Kaplan-Meier method.
RESULTS
The median (interquartile range) patient age was 75 (65-81) years, 18 patients (62.1%) had an American Society of Anesthesiologists classification of ≥3, and 10 patients (34.5%) had a history of prior abdominal surgery. The median estimated blood loss (EBL) was 50 mL and the median length of stay (LOS) was 1 day. Two patients (6.9%) had a perioperative complication and five (17.9%) a post-discharge complication at ≤90 days, all of which were minor. The positive surgical margin rate was 3.6% and in those with muscle-invasive disease a median of 12 lymph nodes were removed. Neither the size of diverticulum nor the need for ureteric re-implantation was predictive of LOS, EBL, or complication (P > 0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncological outcomes. The 5-year overall and recurrence-free survival rates were 79% and 68%, respectively.
CONCLUSION
RAPC confers the ability to achieve favourable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favourably with the published literature. For experienced surgeons, this may represent the optimal surgical approach for organ-preserving bladder surgery.
Topics: Aged; Aged, 80 and over; Cystectomy; Female; Humans; Male; Retrospective Studies; Robotic Surgical Procedures; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 27207269
DOI: 10.1111/bju.13535 -
BMC Urology May 2023Comparing the long-term tumor control results of partial cystectomy(PC)and radical cystectomy(RC)in the treatment of muscle-invasive bladder cancer, and to explore the...
OBJECTIVES
Comparing the long-term tumor control results of partial cystectomy(PC)and radical cystectomy(RC)in the treatment of muscle-invasive bladder cancer, and to explore the feasible method of bladder preservation therapy (BPT)in patients with MIBC.
METHODS
We retrospectively analyzed the clinical data of 102 patients with muscle-invasive bladder cancer in our hospital between January 2012 and December 2018, of whom 32 cases in the partial cystectomy group and 70 cases in the radical cystectomy group. We performed a comparative analysis of patient general information, perioperative-related indicators and postoperative follow-up data, comparing OS, PFS, and DSS at 1, 2, 3, 4, and 5 years in both groups, and comparing tumour recurrence and metastasis in postoperative patients.
RESULTS
All the 102 cases in this study were successfully completed. Partial cystectomy group and Radical cystectomy group median operating time (169.50(130.00 ~ 225.25) min and 420.00(343.75 ~ 483.75) min, p < 0.001), median intraoperative blood loss was (100(50 ~ 100)ml and 400(200 ~ 1000)ml, p < 0.001), median perioperative blood transfusion volume (0(0 ~ 0)ml and 600(150.00 ~ 906.25)ml, p < 0.001), median total hospital stay (18(14.25 ~ 20.00) and 24.5(20.00 ~ 34.25) days, p < 0.001), median preoperative preparation time (7(4.25 ~ 8.00) and 10(8.00 ~ 13.00) days, p < 0.001), median postoperative hospital stay (9(8.00 ~ 13.50) and 14(11.00 ~ 21.25) days, p < 0.001), the incidence of perioperative blood transfusion was (15.6% and 75.7%, p < 0.001), the incidence of surgical complications was(28.1%(9/32) and 50.0%(35/70), p = 0.033), average hospitalization cost ((26435.76 ± 9877.82) yuan and (58464.36 ± 19753.13) yuan, p < 0.001), the differences were statistically significant (p < 0.05). Perioperative mortality (0 vs. 2.9%(2/70), p = 1), and OS at 1, 2, 3, 4, and 5 years after surgery were (80.0%, 59.8%, 56.1%, 51.0%, 44.6% vs. 76.5%, 67.4%, 64.9%, 57.9%, 52.6%, p = 0.524), PFS (68.2%, 64.6%, 60.3%, 54.8%, 54.8% vs. 82.7%, 78.3%, 75.4%, 67.3%, 62.1%, p = 0.259). DSS (89.9%, 72.4%, 68.6%, 68.6%, 62.4% vs. 87.3%, 83.4%, 80.9%, 73.6%, 68.0%, p = 0.424), and the incidence of tumor recurrence or metastasis was (40.0%(12/30) vs. 25.4%(16/63), p = 0.151), the differences were not statistically significant (p > 0.05).
CONCLUSION
In patients with limited solitary T2N0M0 and T3N0M0 muscle-invasive bladder cancer, partial cystectomy plus bladder instillations treatment can achieve comparable tumour control to radical cystectomy. However, patients in the PC group have significant advantages in terms of operative time, intraoperative bleeding, intraoperative and postoperative blood transfusion, preoperative preparation time, total hospital stay, postoperative recovery time, operative costs and operative complications. This option may be considered for such patients with a need for bladder preservation.
Topics: Humans; Urinary Bladder; Cystectomy; Administration, Intravesical; Retrospective Studies; Neoplasm Recurrence, Local; Urinary Bladder Neoplasms; Muscles; Treatment Outcome
PubMed: 37170081
DOI: 10.1186/s12894-023-01267-w -
Current Opinion in Supportive and... Dec 2021To provide a contemporary rationale for bladder preservation as a treatment strategy for muscle-invasive urothelial carcinoma of the bladder. Although the standard of... (Review)
Review
PURPOSE OF REVIEW
To provide a contemporary rationale for bladder preservation as a treatment strategy for muscle-invasive urothelial carcinoma of the bladder. Although the standard of care for this important and serious clinical condition has been radical cystectomy augmented with neoadjuvant systemic chemotherapy, it is associated with substantial morbidity and quality of life (QoL) implications. This article explores the bladder sparing alternatives to radical cystectomy and urinary diversion to assist Urologists, Medical Oncologists, and Palliative Care providers in their informed decision making with patients.
RECENT FINDINGS
Bladder sparing strategies such as partial cystectomy and trimodality therapy offer long-term cancer outcomes comparable to radical cystectomy in carefully selected patients. Moreover, the toxicity profile in patients, having improved over time, is acceptable, including a low risk of salvage cystectomy.
SUMMARY
Bladder preservation therapy offers an alternative to radical cystectomy. In some patients, it can be done with curative intent and in others it can assist with symptom palliation. Bladder preservation can maintain QoL and provide similar oncologic outcomes to radical surgery, although randomized controlled trials have not been performed. Understanding patient selection is a critical step in balancing bladder preservation and cancer survival.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Neoplasm Invasiveness; Quality of Life; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 34726191
DOI: 10.1097/SPC.0000000000000579 -
Minerva Urologica E Nefrologica = the... Aug 2019Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive... (Review)
Review
INTRODUCTION
Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC.
EVIDENCE ACQUISITION
A non-systematic review on all relevant studies with the keywords "Radical cystectomy," "Open," "Robot-assisted," "Complications," "Recurrence," "Survival," "Neobladder," "Potency," "Continence" and "Intracorporeal" was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines.
EVIDENCE SYNTHESIS
RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique.
CONCLUSIONS
As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects.
Topics: Cystectomy; Humans; Minimally Invasive Surgical Procedures; Postoperative Complications; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Neoplasms; Urologic Surgical Procedures
PubMed: 31086134
DOI: 10.23736/S0393-2249.19.03435-0 -
Urologic Oncology Dec 2022Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial...
PURPOSE
Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial cystectomy (PC) in a contemporary cohort of patients at a single institution.
MATERIAL AND METHODS
Records were reviewed for 43 patients with a primary urothelial carcinoma (UC) who had a partial cystectomy with curative intent at Columbia University Medical Center from 2004 to 2019. Endpoints of interest were noninvasive recurrence (defined as any recurrent nonmuscle invasive disease), advanced recurrence (defined as a muscle invasive recurrence or metastasis), and death. We used unadjusted Cox proportional hazards regressions and log rank tests to estimate the association between clinical characteristics and endpoints of interest.
RESULTS
Among 43 patients with bladder cancer treated with partial cystectomy, median patient age was 73 years (interquartile range 67-77.5) and 86% were male. Twenty-three percent of patients received preoperative neoadjuvant chemotherapy (NAC) and 49% of patients were given perioperative intravesical chemotherapy at the time of PC. Pathologic stage was
cystectomy and 8 patients (19%) died of bladder cancer. On univariate analysis, lymphovascular invasion (hazard ratio [HR] 4.4, confidence interval [CI] 1.3-14.3), pathological stage (HR 5.9, CI 1.3-27.4), and NAC (HR 6.5, CI 1.9-22.7) were associated with advanced recurrence. Noninvasive recurrence was associated with not receiving perioperative intravesical chemotherapy (HR 0.7, CI 0.1-6.0). CONCLUSIONS
In well-selected patients, partial cystectomy offers adequate local control of bladder cancer. The risk of systemic progression is similar to reported case series of RC.
Topics: Humans; Male; Aged; Female; Cystectomy; Carcinoma, Transitional Cell; Urinary Bladder Neoplasms; Urinary Bladder; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 36216663
DOI: 10.1016/j.urolonc.2022.09.003 -
Archivio Italiano Di Urologia,... Sep 2022The aim of the study is to make a review of the literature about bladder malakoplakia. (Review)
Review
OBJECTIVE
The aim of the study is to make a review of the literature about bladder malakoplakia.
MATERIAL AND METHODS
We searched articles on the PUBMED web-literature database with the following keywords: "vesical malakoplakia" and "bladder malakoplakia". In the literature we found 254 articles. At final we have excluded 219 articles, including in our study only 35 articles.
RESULTS
The overall average age found was 50.85 years. The average age of men was 43.22 years, while that of women was 53.37 years. 75% of the patient cases were women and 25% were men. Regarding comorbidities, in 5.55% of the cases were missing whereas 47.22% of the patients suffered from recurrent urinary tract infection (UTI) and 19.44% from immune system disorders. Urine culture was positive in 69.44% with E.coli being isolated in 92% of cases. Hydroureteronephrosis was present in 44.44% of the cases: left in 6.25% of cases, right in 18.75% and bilateral in 75%. The mean serum creatinine of patients with hydroureteronephrosis was 5.11 (1-21) mg/dl. The most frequent site of the lesion was the vesicoureteral junction (VUJ) (42.31%), followed by the trigone (38.46%). 30.56% of patients were treated with antibiotic and surgery (transurethral resection of bladder, partial or radical cystectomy), less frequent options were antibiotics alone and surgery alone. The recurrence rate was 15%.
CONCLUSIONS
Malakoplakia is a disorder usually related to other affections, like UTI and immunodepression, and it seem to be caused by an abnormal macrophage function. In almost half of the described cases of isolated bladder malakoplakia, hydroureteronephrosis and renal failure were present.Treatment is not standardized, but both medical and surgical therapies are effective to avoid recurrence.
Topics: Adult; Anti-Bacterial Agents; Creatinine; Cystectomy; Female; Humans; Malacoplakia; Male; Middle Aged; Urinary Bladder
PubMed: 36165484
DOI: 10.4081/aiua.2022.3.350