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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 -
Urologic Oncology Dec 2019We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort. (Comparative Study)
Comparative Study
INTRODUCTION
We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort.
MATERIALS AND METHODS
Patients who underwent partial cystectomy from 2010 to 2014 were identified in the National Cancer Data Base. The primary outcome was surgical margin status. A multivariable logistic regression model was fitted to identify patient, hospital, and surgical factors associated with positive surgical margins (PSMs).
RESULTS
Partial cystectomy was performed in 1,118 patients via open (n = 715, 64%), laparoscopic (n = 209, 19%), and robotic (n = 194, 17%) approaches. Overall, 220 (19.7%) patients had PSMs. The PSM rate by surgical approach was 19.6% for open, 18.2% for laparoscopic, and 21.6% for robotic (P = 0.678). Compared to open partial cystectomy, the laparoscopic (aOR 1.06, 95%CI 0.70-1.60, P = 0.782), and robotic (aOR 1.28, 95%CI 0.85-1.91, P = 0.235) approaches were not significantly different in terms of PSM rate. There were higher odds of PSMs in non-Hispanic blacks (aOR 1.93, 95%CI 1.09-3.39, P = 0.023) compared to non-Hispanic whites, and in patients with muscle invasive bladder cancer (aOR 3.28, 95%CI 2.00-5.37, P < 0.001) or tumor size ≥ 3 cm (aOR 1.67, 95%CI 1.21-2.30, P = 0.002). Tumors in a dome/urachal location had lower odds of a PSM compared to tumors in a nondome/urachal location (aOR 0.67, 95%CI 0.47-0.94, P = 0.022).
CONCLUSIONS
Our results suggest that partial cystectomy using a laparoscopic or robotic-assisted approach is not associated with an increased risk of PSMs compared to open partial cystectomy.
Topics: Aged; Aged, 80 and over; Cystectomy; Female; Humans; Laparoscopy; Male; Margins of Excision; Middle Aged; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 31445895
DOI: 10.1016/j.urolonc.2019.07.018 -
Urology Apr 1997To determine if well-differentiated colonic-type adenocarcinoma of the urachus behaves in a benign fashion, and thus might be treated by segmental rather than radical... (Review)
Review
OBJECTIVES
To determine if well-differentiated colonic-type adenocarcinoma of the urachus behaves in a benign fashion, and thus might be treated by segmental rather than radical cystectomy.
METHODS
A retrospective review of the literature since 1863 with one added case review is presented here. Only cases with photomicrograph confirmation were accepted.
RESULTS
Sixteen previously reported patients with well differentiated colonic-type adenocarcinoma of the urachus were treated by partial cystectomy. None were treated by radical cystectomy. Most (88%) of these patients were cured, whereas all patients (100%) treated in the last 45 years were cured.
CONCLUSIONS
These data support a more limited approach to the surgical excision of these benign-appearing tumors. The influence of this histologic type on the prognosis of patients with urachal tumors has not been previously reported.
Topics: Adenocarcinoma, Mucinous; Aged; Cystectomy; Female; Humans; Retrospective Studies; Urachus
PubMed: 9111622
DOI: 10.1016/s0090-4295(96)00574-2 -
The Canadian Journal of Urology Aug 2012Paraganglioma of the urinary bladder is a rare tumor that often presents with hypertensive crisis during micturition. We herein present the unusual case of a 45-year-old... (Review)
Review
Paraganglioma of the urinary bladder is a rare tumor that often presents with hypertensive crisis during micturition. We herein present the unusual case of a 45-year-old female with metastatic paraganglioma treated with robotic assisted partial cystectomy and pelvic lymphadenectomy. We review the literature regarding the evaluation and management of paraganglioma of the bladder.
Topics: Cystectomy; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Paraganglioma; Pelvis; Robotics; Urinary Bladder Neoplasms
PubMed: 22892264
DOI: No ID Found -
Current Medical Research and Opinion Jul 2020To describe healthcare utilization and cost associated with the short-term and long-term complications of cystectomy among commercially insured bladder cancer patients... (Observational Study)
Observational Study
To describe healthcare utilization and cost associated with the short-term and long-term complications of cystectomy among commercially insured bladder cancer patients in the United States. This retrospective, observational cohort study evaluated adults with bladder cancer receiving a transurethral resection of bladder tumor followed by a partial or radical cystectomy procedure using U.S. administrative claims from the 2005-2015 IBM MarketScan Commercial and Medicare Supplemental databases. Bladder cancer patients were classified into two cohorts: partial cystectomy or radical cystectomy. Cystectomy complications were identified during the cystectomy admission, short-term period, and long-term period. Complication-related utilization and cost outcomes were reported in aggregate during the cystectomy admission and per patient per month (PPPM) during the short-term and long-term follow-up periods. Of 5136 patients who received a cystectomy, 488 (9.5%) received partial cystectomy and 4648 (90.5%) received radical cystectomy. The mean (SD) costs of complications during the cystectomy admission were $11,728 ($43,380) for radical cystectomy and $4657 ($25,668) for partial cystectomy. In the short-term period, PPPM complication-related healthcare costs were $638 [$3793] for partial cystectomy and $2681 [$14,705] for radical cystectomy. In the long-term period, PPPM complication-related healthcare costs were $544 [$2580] for partial cystectomy and $1619 [$7874] for radical cystectomy. Cystectomy-related complications, especially with radical cystectomy, present a substantial financial burden to patients and payers immediately after surgery as well as in the long term. Targeted interventions which improve clinical outcomes but reduce substantial costs associated with cystectomy for bladder cancer are needed.
Topics: Aged; Aged, 80 and over; Cystectomy; Female; Health Care Costs; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Postoperative Complications; Retrospective Studies; Urinary Bladder Neoplasms
PubMed: 32314606
DOI: 10.1080/03007995.2020.1758927 -
World Journal of Urology Dec 2019To describe a green-laser marking technique to assist partial cystectomy, which allows accurate identification of tumour margins, and provide our initial experience with...
PURPOSE
To describe a green-laser marking technique to assist partial cystectomy, which allows accurate identification of tumour margins, and provide our initial experience with ten patients.
METHODS
Between January 2014 and February 2018, ten patients suspected with muscle-invasive bladder cancer and request of bladder-preserving treatment were selected. In each case, bilateral pelvic lymphadenectomy was performed before green-laser assisted laparoscopic partial cystectomy. Under the direct view of cystoscope, the front-firing green-laser incision was performed 0.5-1 cm away from the exterior margin of lesion with adequate depth into the fat tissue. Tumours were then en bloc removed via laparoscope under the tracing of laser beam.
RESULTS
The location of 12 tumours in 10 patients was superior wall in 7 cases, lateral wall in 3 cases, anterior wall in 1 case, and posterior wall in 1 case. All procedures were completed without serious complications. The median operating time was 270 (210-360) min with a median haemoglobin decrease of 11 (3-38) g/L. Nine patients were high-grade transitional cell carcinoma and one patient was urachal carcinoma, and the clinical stage was pT1 in 1 case, pT2 in 4 cases, and pT3 in 5 cases. The pathological evaluation of tumour margins was negative in 10 patients. During the follow-up, no recurrence or metastasis were detected in 8 patients, but 2 patients presented regional recurrence.
CONCLUSION
The use of green-laser marking technique during laparoscopic partial cystectomy is a feasible manoeuvre in assisting the accurate incision and minimizing injury to the remaining bladder.
Topics: Aged; Cystectomy; Female; Humans; Laparoscopy; Laser Therapy; Male; Middle Aged; Neoplasm Invasiveness; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 30843089
DOI: 10.1007/s00345-019-02712-y -
Archivos Espanoles de Urologia Nov 2007Partial cystectomy is a recognized bladder sparing surgical technique. Patient selection is essential in order to optimize long term results. We present our initial...
OBJECTIVES
Partial cystectomy is a recognized bladder sparing surgical technique. Patient selection is essential in order to optimize long term results. We present our initial experience with laparoscopic partial cystectomy performed in a selected group of patients that includes both benign and malignant lesions.
METHODS
Nine patients were surgically treated with laparoscopic partial cystectomy between July 2002 and September 2006 in our institution. Partial cystectomy was indicated for the treatment of a foreign body, endometriosis, urachal adenocarcinoma, trancisional cell carcinoma, acquired lesions of urachus and extravesical tumor. Analyzed surgical variables were operative time, conversion rate, blood loss, hospital stay and catheterization period.
RESULTS
Nine patients with bladder lesions were laparoscopically operated for partial cystectomy. Transperitoneal technique was employed and no conversion to open surgery was performed. Median operative time was 77.77 min (range 30-120 min.). No patient received any transfusion. No intraoperative lesions were verified. Median hospital stay was 4.22 days (range 3-5 d.), median catheterization period was 7 days (range 5-10 d.).
CONCLUSIONS
Laparoscopic partial cystectomy is a doable surgical procedure. It is a useful technique for both benign and malignant bladder disease. In TCC and urachal carcinoma oncological safety prevails. Patient selection is essential for this procedure.
Topics: Cystectomy; Humans; Retrospective Studies; Urinary Bladder Diseases
PubMed: 18077866
DOI: 10.4321/s0004-06142007000900009 -
World Journal of Urology Dec 2017To evaluate perioperative and oncologic outcomes of patients undergoing radical cystectomy (RC) for recurrence of urothelial carcinoma (UC) after prior partial...
PURPOSE
To evaluate perioperative and oncologic outcomes of patients undergoing radical cystectomy (RC) for recurrence of urothelial carcinoma (UC) after prior partial cystectomy (PC), and to compare these outcomes to patients undergoing primary RC.
METHODS
Patients who underwent RC for recurrence of UC after prior PC were matched 1:3 to patients undergoing primary RC based on age, pathologic stage, and decade of surgery. Perioperative and oncologic outcomes were compared using Wilcoxon sign-rank test, McNemars test, the Kaplan-Meier method, and Cox proportional hazards regression analyses.
RESULTS
Overall, the cohorts were well matched on clinical and pathological characteristics. No difference was noted in operative time (median 322 versus 303 min; p = 0.41), estimated blood loss (median 800 versus 700 cc, p = 0.10) or length of stay (median 9 versus 10 days; p = 0.09). Similarly, there were no differences in minor (51.7 versus 44.3%; p = 0.32) or major (10.3 versus 12.6%; p = 0.66) perioperative complications. Median follow-up after RC was 5.0 years (IQR 1.5, 13.1 years). Notably, CSS was significantly worse for patients who underwent RC after PC (10 year-46.8 versus 65.9%; p = 0.03). On multivariable analysis, prior PC remained independently associated with an increased risk of bladder cancer death (HR 2.28; 95% CI 1.17, 4.42).
CONCLUSIONS
RC after PC is feasible, without significantly adverse perioperative outcomes compared to patients undergoing primary RC. However, the risk of death from bladder cancer may be higher, suggesting the need for careful patient counseling prior to PC and the consideration of such patients for adjuvant therapy after RC.
Topics: Aged; Carcinoma, Transitional Cell; Cystectomy; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local; Outcome and Process Assessment, Health Care; Postoperative Complications; Proportional Hazards Models; Risk Assessment; United States; Urinary Bladder Neoplasms; Urothelium
PubMed: 28913657
DOI: 10.1007/s00345-017-2087-4 -
International Journal of Urology :... Oct 2019
Editorial Comment from Dr Kojima to Renal function after bladder-preserving therapy for patients with muscle-invasive bladder cancer: Results of selective bladder-preserving tetramodality therapy consisting of maximal transurethral resection, induction chemoradiotherapy and partial cystectomy.
Topics: Chemoradiotherapy; Cystectomy; Humans; Organ Sparing Treatments; Urinary Bladder Neoplasms
PubMed: 31353632
DOI: 10.1111/iju.14074 -
International Journal of Urology :... Oct 2019
Editorial Comment from Dr Kobayashi to Renal function after bladder-preserving therapy for patients with muscle-invasive bladder cancer: Results of selective bladder-preserving tetramodality therapy consisting of maximal transurethral resection, induction chemoradiotherapy and partial cystectomy.
Topics: Chemoradiotherapy; Cystectomy; Humans; Organ Sparing Treatments; Urinary Bladder Neoplasms
PubMed: 31327166
DOI: 10.1111/iju.14075