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Journal of Healthcare Engineering 2022The aim of this study is to examine the treatment pattern and predictors of long-term survival of patients with primary signet ring cell carcinoma (PSRCC) of the urinary...
INTRODUCTION
The aim of this study is to examine the treatment pattern and predictors of long-term survival of patients with primary signet ring cell carcinoma (PSRCC) of the urinary bladder based on the analysis of the SEER database.
METHODS
The 3-year and 5-year overall survival (OS) and cancer-specific survival (CSS) were calculated using the Kaplan-Meier method. Then, we compared the CSS curves by the log-rank test. The independent risk factors were determined using univariate and multivariate Cox regression.
RESULTS
The 3-year OS and CSS rates for PSRCC of the bladder were 25.3% and 33.3%. The 5-year OS and CSS rates for the entire cohort were 16.4% and 25.2%. The CSS rates, respectively, were 0, 25.0, 66.7, 33.2, 42.4, and 31.7% at 3 years and 0, 25.0, 34.3, 24.1, 27.2, and 31.7% at 5 years for none, transurethral resection of the bladder (TURB), partial cystectomy, radical cystectomy with reconstruction, pelvic exenteration, and other surgeries ( = 0.001). Multivariate analyses showed independent risk factors only including T stage, M stage, lymph node removal, and surgical approach.
CONCLUSIONS
T stage, M stage, lymph node removal, and surgical approach are independent risk factors of PSRCC of the urinary bladder. TURB and radical cystectomy with reconstruction appear to provide a better outcome.
Topics: Carcinoma, Signet Ring Cell; Cystectomy; Humans; Prognosis; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 36105716
DOI: 10.1155/2022/3224616 -
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 -
Urologic Oncology Jun 2016Bladder preservation surgical strategies for the treatment of invasive bladder cancer have been developed to provide options to those patients who are medically unfit to... (Review)
Review
PURPOSE
Bladder preservation surgical strategies for the treatment of invasive bladder cancer have been developed to provide options to those patients who are medically unfit to undergo radical extirpative surgery or prefer conservative therapy for limited disease. The purpose of this manuscript is to review the available bladder-preserving surgical techniques for treatment of muscle-invasive bladder cancer.
METHODS
We performed a thorough literature search to determine the available bladder-preserving treatments for muscle-invasive bladder cancer as well as their corresponding outcomes.
RESULTS
Available surgical strategies include radical transurethral resection (TUR) with or without neoadjuvant chemotherapy, partial cystectomy and multi-modal therapy. Patient selection is critical in determining which patients can safely be offered bladder preservation therapies. Disease characteristics that portend more favorable outcomes in the setting of bladder preservation include cT2 stage, unifocal tumor, the absence of carcinoma in situ and hydronephrosis, and complete TUR. Several new technologies, including fluorescence and cryoablation treatment, have been incorporated into existing treatment modalities to improve surgical precision and margins. Ongoing studies aimed at improving the accuracy of clinical staging can further refine patient selection and improve clinical outcomes.
CONCLUSIONS
Surgical bladder preservation techniques for treatment of invasive bladder cancer requires careful, long-term follow-up. Prospective, randomized studies comparing bladder sparing treatment modalities with radical cystectomy are needed, but ultimately will be difficult to accrue due to a variety of factors.
Topics: Combined Modality Therapy; Cystectomy; Humans; Neoplasm Invasiveness; Organ Sparing Treatments; Urinary Bladder Neoplasms
PubMed: 26725219
DOI: 10.1016/j.urolonc.2015.11.023 -
Der Urologe. Ausg. A Oct 2014Persistent unexplained urological complaints and diseases are a common problem in clinical practice. Psychological components can play an important role in urological... (Review)
Review
BACKGROUND
Persistent unexplained urological complaints and diseases are a common problem in clinical practice. Psychological components can play an important role in urological complaints. Neglect of these facts can lead to an insufficient or incorrect treatment. Therefore, apart from the specific medical diagnostics, a complete examination of mental and psychological functions before an invasive intervention is also required.
PSYCHOSOMATICS IN UROLOGY
Illustrated by the case of a young woman with a request for a cystectomy while suffering from a chronic pollakiuria, this paper explains the importance of good interdisciplinary collaboration for evidence-based, guideline-oriented medical treatment. The patient's suffering and urge for removing the bladder was contrasted by a lack of medical indication for surgery and the principle of proportionality. The essay gives insight into the discipline of psychosomatic medicine, somotoform disorders found in urology and, especially, the symptoms of pollakiuria and overactive bladder.
CONCLUSION
The case illustrates the importance of timely and simultaneous medical and psychosocial diagnostics for the treatment outcome in patients with unspecific physical complaints. Treatment recommendations for patients with somatoform complaints in clinical practice are provided.
Topics: Adult; Chronic Disease; Cystectomy; Female; Humans; Psychotherapy; Somatoform Disorders; Urination Disorders
PubMed: 25214314
DOI: 10.1007/s00120-014-3618-x -
Urologic Oncology Sep 2017Different sexual function-preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have... (Review)
Review
INTRODUCTION
Different sexual function-preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review is to determine the effect of sexual function-preserving cystectomy (SPC) on functional and oncological outcomes.
MATERIALS AND METHODS
Relevant databases were searched covering the time frame 2000 to 2015. All publications presenting data on any type of SPC reporting oncological or functional outcomes with a minimum follow-up of 1 year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied.
RESULTS
In a total of 8,517 identified abstracts, 12 studies were eligible for inclusion. SPC described included prostate-, capsule-, seminal vesicle, and nerve-sparing techniques. Local recurrence ranged from 1.2% to 61.1% (vs. 16.0%-55.0% in the control group) and metastatic disease from 0% to 33.3% (vs. 33.0%). No differences were found in comparative studies reporting oncological outcomes. Postoperative potency was significantly better in the SPC groups in 6 studies comparing sexual function-preserving cystectomy vs. radical cystectomy (P<0.05). No major effect on continence was found. Overall, there was moderate to high risk of bias and confounding.
CONCLUSIONS
The evidence base for prostate-, capsule-, or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counseled, and closely monitored.
Topics: Cystectomy; Humans; Male; Sexual Health; Urinary Bladder Neoplasms
PubMed: 28495555
DOI: 10.1016/j.urolonc.2017.04.013 -
Urology Aug 2017To report the first exclusively pediatric series of robot-assisted urachal remnant excisions in children.
OBJECTIVE
To report the first exclusively pediatric series of robot-assisted urachal remnant excisions in children.
METHODS
We reviewed the medical records of all children who underwent robot-assisted excision of urachal remnants from 2010 to 2016. For the procedure, a 3-port approach was performed in all cases. Excision of the urachus was performed, along with partial cystectomy if there was clear or suspected bladder involvement. Outcomes and complications were reviewed.
RESULTS
Sixteen cases of robotic urachal excision were performed during the study period in patients aged 0.8-16.5 years. Complete excision was accomplished in all cases with no conversions. Partial cystectomy was performed in 11 cases, in which a urinary catheter was left for 1 day in all cases (no catheter was left in the absence of partial cystectomy). The only complication was a bladder leak requiring open surgical repair. There were no bowel injuries or hernias. The median operative time was 107 minutes. The length of stay was 2 days with partial cystectomy and 1 day without partial cystectomy. All patients were well at follow-up.
CONCLUSION
We report the largest known series of robot-assisted urachal remnant excisions in children, demonstrating this minimally invasive approach to be safe and effective.
Topics: Adolescent; Child; Child, Preschool; Cystectomy; Cystoscopy; Female; Humans; Infant; Laparoscopy; Male; Operative Time; Retrospective Studies; Robotics; Treatment Outcome; Urachus; Urologic Surgical Procedures
PubMed: 28431995
DOI: 10.1016/j.urology.2017.03.044 -
The Urologic Clinics of North America May 2018Radical cystectomy is a morbid procedure performed on an aging and often frail population. Nonetheless, advances in preoperative and intraoperative management have... (Review)
Review
Radical cystectomy is a morbid procedure performed on an aging and often frail population. Nonetheless, advances in preoperative and intraoperative management have significantly improved patient outcomes. Preoperative optimization includes a focus on patient education, risk factor reduction, risk stratification, nutritional optimization, and bowel motility enhancement. Intraoperative optimization focuses on maintaining normothermia, restrictive fluid administration, minimization of blood transfusions, and nonopioid pain management.
Topics: Cystectomy; Humans; Intraoperative Care; Patient Education as Topic; Preoperative Care; Risk Assessment; Urinary Bladder Neoplasms
PubMed: 29650133
DOI: 10.1016/j.ucl.2017.12.003 -
PloS One 2015To critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC).
METHODS
A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in April 2014. All relevant studies comparing RARC with ORC were included for further screening. A pooled meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.
RESULTS
Nineteen studies were included for the analysis, including a total of 1779 patients (787 patients in the RARC group and 992 patients in the ORC group). Although RARC was associated with longer operative time (p <0.0001), patients in this group might benefit from significantly lower overall perioperative complication rates within 30 days and 90 days (p = 0.005 and 0.0002, respectively), more lymph node yields (p = 0.009), less estimated blood loss (p <0.00001), lower need for perioperative and intraoperative transfusions (p <0.0001 and <0.0001, respectively), and shorter postoperative length of stay (p = 0.0002). There was no difference between two groups regarding positive surgical margin rates (p = 0.19).
CONCLUSIONS
RARC appears to be an efficient alternative to ORC with advantages of less perioperative complications, more lymph node yields, less estimated blood loss, lower need for transfusions, and shorter postoperative length of stay. Further studies should be performed to compare the long-term oncologic outcomes between RARC and ORC.
Topics: Cystectomy; Female; Humans; Male; Middle Aged; Robotics
PubMed: 25825873
DOI: 10.1371/journal.pone.0121032 -
The Kaohsiung Journal of Medical... Apr 2016Radical cystectomy has remained the gold standard for recurrent superficial or muscle invasive bladder tumor. However, partial cystectomy still has a role in those who...
Radical cystectomy has remained the gold standard for recurrent superficial or muscle invasive bladder tumor. However, partial cystectomy still has a role in those who reject or have contraindications for radical cystectomy. In this study, we sought to identify predictors of bladder recurrence and overall survival after simple partial cystectomy. We included 27 patients with bladder tumor who received simple partial cystectomy without pelvic lymph node dissection between March 2000 and September 2013. Adjuvant chemotherapy or radiation therapy was prescribed according to the pathological results. Parameters were compared on the basis of bladder recurrence and overall survival. During a mean follow-up time of 39 months, five patients (18.5%) experienced bladder recurrence. An older age, a higher pathological stage, positive surgical margins, and distant metastases were significant predictors of overall survival (p = 0.031, p = 0.001, p = 0.001, and p = 0.011, respectively). Meanwhile, previous bladder instillation and positive surgical margins were significant predictors of bladder recurrence (p = 0.026 and p = 0.027, respectively). The rate of consecutive distant metastases (33.3%) was almost twice the rate of bladder recurrence (18.5%), and six patients developed consecutive distant metastases without first experiencing bladder recurrence. In patients who received a simple partial cystectomy as an alternative treatment, previous bladder instillation and positive surgical margins were significant predictors of bladder recurrence. Patients with an older age, positive surgical margins, and consecutive distant metastases had worse overall survival. Partial cystectomy with routine lymph node dissection may be a better option for achieving favorable long-term outcomes.
Topics: Aged; Aged, 80 and over; Cystectomy; Disease-Free Survival; Female; Humans; Male; Middle Aged; Prognosis; Treatment Outcome; Urinary Bladder Neoplasms; Urothelium
PubMed: 27185601
DOI: 10.1016/j.kjms.2016.02.008 -
Urologic Oncology Jan 2023Urachal carcinoma (UC) is a rare genitourinary cancer with an insidious onset, high risk of recurrence, and a poor prognosis. Surgical resection alone has difficulty in...
PURPOSE
Urachal carcinoma (UC) is a rare genitourinary cancer with an insidious onset, high risk of recurrence, and a poor prognosis. Surgical resection alone has difficulty in controlling the tumor. We aim to explore treatment options and prognostic risk factors for UC based on a multicenter cohort and long-term follow-up database.
MATERIALS AND METHODS
The clinical data, treatment and follow-up results of 163 patients with UC in 6 medical centers were analyzed retrospectively. Kaplan-Meier analysis and a Cox proportional hazards model were used to assess the treatment options and prognostic risk factors for UC.
RESULTS
Kaplan-Meier analysis showed no difference in the 5-year recurrence-free survival rate (P =0.282) or overall survival rate (P =0.673) between extended partial cystectomy (EPC) and radical cystectomy (RC) for patients at stage III and below. Whether bilateral pelvic lymph nodes were dissected was also not significantly correlated with the patient's recurrence (P =0.921) or prognosis (P =0.741). Postoperative adjuvant chemotherapy significantly reduced the recurrence rate of patients with stage Ⅲb or below (P =0.005). Combined treatment of postoperative recurrence patients prolonged the survival time of patients compared with single chemotherapy or conservative treatment (34.022±5.031 vs. 12.837±2.349 or 6.192±0.875 months, P <0.001). Kaplan-Meier and univariate Cox regression analyses showed that age >55 years, Sheldon stage, carbohydrate antigen 19-9 (CA19-9) >9.935 U/mL, carbohydrate antigen 72-4 (CA724) >6.02 U/mL, and postoperative adjuvant chemotherapy were closely related to the overall survival and recurrence-free survival of patients (P <0.05). Multivariate Cox proportional hazard regression confirmed that the Sheldon stage and CA724 >6.02 U/mL were independent recurrence risk factors.
CONCLUSIONS
EPC or RC provides similar oncologic results for UC, but bilateral pelvic lymph node dissection is not necessary in early-stage patients. Postoperative adjuvant chemotherapy can significantly reduce the recurrence rate, and combination therapy may provide better survival outcomes. CA724 can predict tumor recurrence or metastasis at an early stage.
Topics: Humans; Middle Aged; Chemotherapy, Adjuvant; Cystectomy; Lymph Node Excision; Neoplasm Staging; Prognosis; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 36283930
DOI: 10.1016/j.urolonc.2022.09.017