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Feng Y, Wang J, Zhou A, Wu H, Xu W, Xu Y. Short-term outcomes comparison of KangDuo 2.0 and Da Vinci Xi in radical cystectomy. Sci Rep 2025; 15:11739. [PMID: 40188251 PMCID: PMC11972294 DOI: 10.1038/s41598-025-95382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 03/20/2025] [Indexed: 04/07/2025] Open
Abstract
In urological surgery, the Da Vinci Xi robotic system has many advantages, but it also has limitations such as high equipment costs and the need for professional training. Kangduo is a laparoscopic surgical robot developed in China, and SR2000 is its newly approved four-arm laparoscopic surgical robot. This study compares the short-term outcomes of the two in radical cystectomy. Data from a centre-based randomised non-inferiority trial were used and patients between March 2023 and June 2024 were enrolled and randomised according to criteria. The primary outcome was surgical success, and secondary outcomes included intraoperative variables, surgical outcomes, pathological outcomes, and postoperative outcomes. A total of 34 patients, 16 in the KD group and 18 in the DV group, had no intermediate open or conventional laparoscopic surgery, and the surgical success rate was 100%, with no significant differences between the two groups in many aspects. The effectiveness and safety of the KangDuo SR2000 system were demonstrated. Experienced surgeons confirmed that performing radical cystectomy using the KangDuo SR2000 system yielded results comparable to those achieved using the Da Vinci robotic system.
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Affiliation(s)
- Yue Feng
- Department of Urology Surgery, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150000, Heilongjiang Province, People's Republic of China
| | - Jing Wang
- Department of Gynecology, The Red Cross Center Hospital of Harbin, No. 415, Xinyang Road, Daoli District, Harbin, 150000, Heilongjiang Province, People's Republic of China
| | - Ailin Zhou
- Department of Urology Surgery, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150000, Heilongjiang Province, People's Republic of China
| | - Hao Wu
- Department of Urology Surgery, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150000, Heilongjiang Province, People's Republic of China
| | - Wanhai Xu
- Department of Urology Surgery, Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150000, Heilongjiang Province, People's Republic of China.
| | - Yangyang Xu
- Department of Urology Surgery, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150000, Heilongjiang Province, People's Republic of China.
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Hiyama Y, Shindo T, Takahashi A, Fukuta F, Maehana T, Tachikawa K, Hashimoto K, Kobayashi K, Tanaka T, Takahashi S, Masumori N. The incidence and risk factor for febrile urinary tract infection after robot-assisted laparoscopic radical cystectomy in bladder cancer patients. J Infect Chemother 2025; 31:102624. [PMID: 39824249 DOI: 10.1016/j.jiac.2025.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 12/25/2024] [Accepted: 01/13/2025] [Indexed: 01/20/2025]
Abstract
INTRODUCTION Febrile urinary tract infections are major complications of radical cystectomy; however, their characteristics after robot-assisted radical cystectomy remain unclear. Thus, we investigated the rate, severity, pathogens, and risk factors of febrile urinary tract infections after robot-assisted radical cystectomy. PATIENTS AND METHODS Patients who underwent robot-assisted radical cystectomy at three institutions between April 2018 and March 2022 were retrospectively analyzed. The febrile urinary tract infections occurring within 90 days of surgery were evaluated. RESULTS Overall, 191 patients were included. Of the 157 patients with ileal urinary diversions, 138 and 19 received ileal conduit and ileal neobladder, respectively; 42 febrile urinary tract infections were observed in 36 patients (22.9 %). Of the 32 patients who underwent cutaneous ureterostomy, four patients had febrile urinary tract infections (12.5 %). The incidence of postoperative febrile urinary tract infections was significantly higher in patients with ileal neobladder (52.9 %) than in those with an ileal conduit (18.8 %) (p < 0.05, log-rank test). Gram-positive strains were the dominant pathogen (60.0 %), followed by gram-negative strains (37.1 %) and fungi (2.9 %). The blood culture was positive in 28.6 % for febrile urinary tract infections. The primarily isolated strains were Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa. Female was the only risk factor for febrile urinary tract infections in those with an ileal conduit. CONCLUSIONS Gram-positive strains account for 60 % of pathogens causing febrile urinary tract infections after robot-assisted radical cystectomy, that may cause severe complications, rendering management of febrile urinary tract infections paramount.
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Affiliation(s)
- Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Urology, NTT Medical Center Sapporo, Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Fumimasa Fukuta
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Takeshi Maehana
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kimihito Tachikawa
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Takahashi
- Department of Infection Control & Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Introini C, Sequi MB, Ennas M, Benelli A, Guano G, Pastore AL, Carbone A. Sexual-Sparing Radical Cystectomy in the Robot-Assisted Era: A Review on Functional and Oncological Outcomes. Cancers (Basel) 2025; 17:110. [PMID: 39796736 PMCID: PMC11720003 DOI: 10.3390/cancers17010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 12/29/2024] [Accepted: 12/30/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients. Methods: A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed. Results: Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function. Conclusions: Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption.
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Affiliation(s)
- Carlo Introini
- E.O. Ospedali Galliera, UOC Urologia, 16128 Genova, Italy
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Marco Ennas
- E.O. Ospedali Galliera, UOC Urologia, 16128 Genova, Italy
| | - Andrea Benelli
- E.O. Ospedali Galliera, UOC Urologia, 16128 Genova, Italy
| | - Giovanni Guano
- E.O. Ospedali Galliera, UOC Urologia, 16128 Genova, Italy
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
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Wong CHM, Ko ICH, Kang SH, Kitamura K, Horie S, Muto S, Ohyama C, Hatakeyama S, Patel M, Yang CK, Kijvikai K, Youl LJ, Chen HG, Zhang RY, Lin TX, Lee LS, Teoh JYC, Chan E. Long-Term Outcomes of Orthotopic Neobladder Versus Ileal Conduit Urinary Diversion in Robot-Assisted Radical Cystectomy (RARC): Multicenter Results from the Asian RARC Consortium. Ann Surg Oncol 2024; 31:5785-5793. [PMID: 38802711 PMCID: PMC11300606 DOI: 10.1245/s10434-024-15396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Robot-assisted radical cystectomy (RARC) has gained traction in the management of muscle invasive bladder cancer. Urinary diversion for RARC was achieved with orthotopic neobladder and ileal conduit. Evidence on the optimal method of urinary diversion was limited. Long-term outcomes were not reported before. This study was designed to compare the perioperative and oncological outcomes of ileal conduit versus orthotopic neobladder cases of nonmetastatic bladder cancer treated with RARC. PATIENTS AND METHODS The Asian RARC consortium was a multicenter registry involving nine Asian centers. Consecutive patients receiving RARC were included. Cases were divided into the ileal conduit and neobladder groups. Background characteristics, operative details, perioperative outcomes, recurrence information, and survival outcomes were reviewed and compared. Primary outcomes include disease-free and overall survival. Secondary outcomes were perioperative results. Multivariate regression analyses were performed. RESULTS From 2007 to 2020, 521 patients who underwent radical cystectomy were analyzed. Overall, 314 (60.3%) had ileal conduit and 207 (39.7%) had neobladder. The use of neobladder was found to be protective in terms of disease-free survival [Hazard ratio (HR) = 0.870, p = 0.037] and overall survival (HR = 0.670, p = 0.044) compared with ileal conduit. The difference became statistically nonsignificant after being adjusted in multivariate cox-regression analysis. Moreover, neobladder reconstruction was not associated with increased blood loss, nor additional risk of major complications. CONCLUSIONS Orthotopic neobladder urinary diversion is not inferior to ileal conduit in terms of perioperative safety profile and long-term oncological outcomes. Further prospective studies are warranted for further investigation.
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Affiliation(s)
- Chris Ho-Ming Wong
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ivan Ching-Ho Ko
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kousuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University, Hirosaki, Japan
| | | | - Manish Patel
- Department of Urology, The University of Sydney, Sydney, Australia
| | - Cheung-Kuang Yang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kittinut Kijvikai
- Department of Urology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand
| | - Lee Ji Youl
- Department of Urology, Catholic University of Korea, Seoul, Republic of Korea
| | - Hai-Ge Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rui-Yun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tian-Xin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Eddie Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wong CHM, Ko ICH, Leung DKW, Kang SH, Kitamura K, Horie S, Muto S, Ohyama C, Hatakeyama S, Patel M, Yang CK, Kijvikai K, Lee JY, Chen HG, Zhang RY, Lin TX, Lee LS, Teoh JYC, Chan E. Pre-Op Hydronephrosis Predicts Outcomes in Patients Receiving Robot-Assisted Radical Cystectomy. Cancers (Basel) 2024; 16:2826. [PMID: 39199597 PMCID: PMC11353176 DOI: 10.3390/cancers16162826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/30/2024] [Accepted: 08/07/2024] [Indexed: 09/01/2024] Open
Abstract
INTRODUCTION Robot-assisted radical cystectomy (RARC) has gained momentum in the management of muscle invasive bladder cancer (MIBC). Predictors of RARC outcomes are not thoroughly studied. We aim to investigate the implications of preoperative hydronephrosis on oncological outcomes. PATIENTS AND METHODS This study analysed data from the Asian RARC consortium, a multicentre registry involving nine Asian centres. Cases were divided into two groups according to the presence or absence of pre-operative hydronephrosis. Background characteristics, operative details, perioperative outcomes, and oncological results were reviewed. Outcomes were (1) survival outcomes, including 10-year disease-free survival (DFS) and overall survival (OS), and (2) perioperative and pathological results. Multivariate regression analyses were performed on survival outcomes. RESULTS From 2007 to 2020, 536 non-metastatic MIBC patients receiving RARC were analysed. 429 had no hydronephrosis (80.0%), and 107 (20.0%) had hydronephrosis. Hydronephrosis was found to be predictive of inferior DFS (HR = 1.701, p = 0.003, 95% CI = 1.196-2.418) and OS (HR = 1.834, p = 0.008, 95% CI = 1.173-2.866). Subgroup analysis demonstrated differences in the T2-or-above subgroup (HR = 1.65; p = 0.004 in DFS and HR = 1.888; p = 0.008 in OS) and the T3-or-above subgroup (HR = 1.757; p = 0.017 in DFS and HR = 1.807; p = 0.034 in OS). CONCLUSIONS The presence of preoperative hydronephrosis among MIBC patients carries additional prognostic implications on top of tumour staging. Its importance in case selection needs to be highlighted.
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Affiliation(s)
- Chris Ho-Ming Wong
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ivan Ching-Ho Ko
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - David Ka-Wai Leung
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Kousuke Kitamura
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Shigeo Horie
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Satoru Muto
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University, Hirosaki 036-8561, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University, Hirosaki 036-8561, Japan
| | - Manish Patel
- Department of Urology, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Cheung-Kuang Yang
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan, China
| | - Kittinut Kijvikai
- Department of Urology, Ramathibodi Hospital, Mahidol University, Nakhon Pathom 10400, Thailand
| | - Ji Youl Lee
- Department of Urology, Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Hai-Ge Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Rui-Yun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Tian-Xin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Eddie Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Cheema MJ, Hassan MMU, Asim A, Nathaniel E, Shafeeq MI, Tayyab MA, Rahim Valiyakath C, Abdallah S, Usman A. Innovations in Hybrid Laparoscopic Surgery: Integrating Advanced Technologies for Multidisciplinary Cases. Cureus 2024; 16:e63219. [PMID: 39070515 PMCID: PMC11279072 DOI: 10.7759/cureus.63219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Combining conventional laparoscopic techniques with cutting-edge technologies, such as robotics, improved imaging, and flexible equipment, hybrid laparoscopic techniques represent a revolutionary advancement in minimally invasive surgery. These methods have several benefits, such as increased accuracy, quicker healing periods, and fewer complications, which makes them especially useful in complicated multidisciplinary situations. The historical evolution, uses, benefits, and drawbacks of hybrid laparoscopic procedures are examined in this narrative review, which also covers urological, gastrointestinal, cardiothoracic, and gynecological surgery. The review focuses on how these methods promote interdisciplinary cooperation and creativity by enabling more accurate and successful surgical operations. It also discusses the equipment needs, integration difficulties, and technical difficulties that need to be resolved to reach the full potential of hybrid laparoscopic surgery. For hybrid laparoscopic procedures to become more widely used and effective in the future, there is a need for specialized training programs, interdisciplinary research collaborations, and ongoing technological advancements.
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Affiliation(s)
| | | | - Aiman Asim
- Medicine and Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | | | | | | | | | - Ali Usman
- General Surgery, Nishtar Medical University, Multan, PAK
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Gavi F, Foschi N, Fettucciari D, Russo P, Giannarelli D, Ragonese M, Gandi C, Balocchi G, Francocci A, Bizzarri FP, Marino F, Filomena GB, Palermo G, Totaro A, Racioppi M, Bientinesi R, Sacco E. Assessing Trifecta and Pentafecta Success Rates between Robot-Assisted vs. Open Radical Cystectomy: A Propensity Score-Matched Analysis. Cancers (Basel) 2024; 16:1270. [PMID: 38610948 PMCID: PMC11011078 DOI: 10.3390/cancers16071270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the surgical and oncological outcomes of robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) using trifecta and pentafecta parameters. METHODS The clinical data of 41 patients who underwent RARC between 2018 and 2022 were prospectively collected and retrospectively compared to those of 330 patients undergoing ORC using 1:1 propensity score matching. Trifecta was defined as simultaneous negative surgical margins (SMs), a lymph node (LN) yield ≥ 16, and the absence of major complications (Clavien-Dindo grade III-V) within 90 days postoperatively. Pentafecta additionally included a 12-month recurrence-free rate and a time between the transurethral resection of a bladder tumor (TURBT) and radical cystectomy (RC) ≤ 3 months. The continuous variables were compared using the Mann-Whitney U test, and the categorical variables were analyzed using the chi-squared test. RESULTS No statistically significant differences in trifecta and pentafecta success rates were observed between the RARC and ORC cohorts after propensity score matching. However, the RARC group exhibited significantly reduced blood loss (RARC: 317 mL vs. ORC: 525 mL, p = 0.01). CONCLUSIONS RARC offers distinct advantages over ORC in terms of reduced blood loss, while trifecta and pentafecta success rates do not differ significantly between the two surgical approaches.
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Affiliation(s)
- Filippo Gavi
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Daniele Fettucciari
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Giovanni Balocchi
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Alessandra Francocci
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Francesco Pio Bizzarri
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Filippo Marino
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Giovanni Battista Filomena
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Marco Racioppi
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Emilio Sacco
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Urology Department, Isola Tiberina Gemelli Isola Hospital, Catholic University Medical School, 00168 Rome, Italy
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Sahni DS, Oberoi AS, Ramsaha S, Teahan S, Morton S. Incidence of Ureteroenteric Anastomotic Strictures After Robotic vs Open Cystectomy in Adults. Urology 2024; 185:100-108. [PMID: 38309596 DOI: 10.1016/j.urology.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
To synthesise the evidence comparing the incidence rates of UAS post-RARC vs Open Radical cystectomy (ORC) in adults undergoing cystectomy and to compare differential stricture rates between Extracorporeal and Intracorporeal urinary diversion (ECUD vs ICUD). The primary outcome was incidence rate of UAS post RARC vs ORC and the secondary outcome was incidence rate of UAS in RARC post ECUD vs ICUD. Review authors conducted comprehensive search for studies comparing RARC with ORC in terms of incidence of UAS. Furthermore, we conducted a secondary search for studies which compared UAS incidence comparing ECUD and ICUD. We found that RARC may have higher incidence of UAS [OR: 1.39; 95% CI 1.11-1.75; p < 0.0001]. ECUD may result in lower rate of UAS as compared to ICUD [OR: 0.74; 95% CI 0.56 to 0.98; p= 0.04].
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Affiliation(s)
- Dhruv Satya Sahni
- Department of Urology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK; College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Ajit Singh Oberoi
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India; Department of General Surgery, Royal Albert Edward Infirmary, WWL NHS Trust, Wigan, UK
| | - Srishti Ramsaha
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Seamus Teahan
- Department of Urology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Simon Morton
- Department of Urology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
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9
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Fan LW, Li YR, Wu CM, Chuang KT, Li WC, Liu CY, Chang YH. Inpatient Outcomes of Patients Undergoing Robot-Assisted versus Laparoscopic Radical Cystectomy for Bladder Cancer: A National Inpatient Sample Database Study. J Clin Med 2024; 13:772. [PMID: 38337466 PMCID: PMC10856412 DOI: 10.3390/jcm13030772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Bladder cancer is a common urinary tract malignancy. Minimally invasive radical cystectomy has shown oncological outcomes comparable to the conventional open surgery and with advantages over the open procedure. However, outcomes of the two main minimally invasive procedures, robot-assisted and pure laparoscopic, have yet to be compared. This study aimed to compare in-hospital outcomes between these two techniques performed for patients with bladder cancer. Methods: This population-based, retrospective study included hospitalized patients aged ≥ 50 years with a primary diagnosis of bladder cancer who underwent robot-assisted or pure laparoscopic radical cystectomy. All patient data were extracted from the US National Inpatient Sample (NIS) database 2008-2018 and were analyzed retrospectively. Primary outcomes were in-hospital mortality, prolonged length of stay (LOS), and postoperative complications. Results: The data of 3284 inpatients (representing 16,288 US inpatients) were analyzed. After adjusting for confounders, multivariable analysis revealed that patients who underwent robot-assisted radical cystectomy had a significantly lower risk of in-hospital mortality (adjusted OR [aOR], 0.50, 95% CI: 0.28-0.90) and prolonged LOS (aOR, 0.63, 95% CI: 0.49-0.80) than those undergoing pure laparoscopic cystectomy. Patients who underwent robot-assisted radical cystectomy had a lower risk of postoperative complications (aOR, 0.69, 95% CI: 0.54-0.88), including bleeding (aOR, 0.73, 95% CI: 0.54-0.99), pneumonia (aOR, 0.49, 95% CI: 0.28-0.86), infection (aOR, 0.55, 95% CI: 0.36-0.85), wound complications (aOR, 0.33, 95% CI: 0.20-0.54), and sepsis (aOR, 0.49, 95% CI: 0.34-0.69) compared to those receiving pure laparoscopic radical cystectomy. Conclusions: Patients with bladder cancer, robot-assisted radical cystectomy is associated with a reduced risk of unfavorable short-term outcomes, including in-hospital mortality, prolonged LOS, and postoperative complications compared to pure laparoscopic radical cystectomy.
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Affiliation(s)
- Le-Wei Fan
- Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei 236, Taiwan (W.-C.L.); (C.-Y.L.)
| | - Yun-Ren Li
- Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei 236, Taiwan (W.-C.L.); (C.-Y.L.)
| | - Cheng-Mu Wu
- Department of Biotechnology and Laboratory Science in Medicine, National Tang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Kai-Ti Chuang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei 236, Taiwan
| | - Wei-Chang Li
- Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei 236, Taiwan (W.-C.L.); (C.-Y.L.)
| | - Chung-Yi Liu
- Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei 236, Taiwan (W.-C.L.); (C.-Y.L.)
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei 236, Taiwan (W.-C.L.); (C.-Y.L.)
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10
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Shishkov DD, Shishkov DG, Todorov S, Mihaylov N. Laparoscopic vs. open surgical access radical cystectomy with subsequent orthotopic reconstruction in the treatment of invasive urothelial carcinoma of the bladder. Folia Med (Plovdiv) 2023; 65:894-901. [PMID: 38351777 DOI: 10.3897/folmed.65.e101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/07/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Radical cystectomy combined with extended lymph node dissection is the treatment of choice for muscle-invasive bladder cancer and can be performed using open, laparoscopic, or robot-assisted surgical access.
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Affiliation(s)
| | | | - Stefan Todorov
- Clinic of Urology, St George University Hospital,, Plovdiv, Bulgaria
| | - Nikola Mihaylov
- Clinic of Urology, St George University Hospital,, Plovdiv, Bulgaria
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11
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Peng Y, Liu Y, Lai S, Li Y, Lin Z, Hao L, Dong J, Li X, Huang K. Global trends and prospects in health economics of robotic surgery: a bibliometric analysis. Int J Surg 2023; 109:3896-3904. [PMID: 37720937 PMCID: PMC10720792 DOI: 10.1097/js9.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/20/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Over 10 million robotic surgeries have been performed. However, the cost and benefit of robotic surgery need to be evaluated to help hospitals, surgeons, patients, and payers make proper choices, making a health economic analysis necessary. The authors revealed the bibliometric profile in the field of health economics of robotic surgery to prompt research development and guide future studies. MATERIALS AND METHODS The Web of Science Core Collection scientific database was searched for documents indexed from 2003 to 31 December 2022. Document types, years, authors, countries, institutions, journal sources, references, and keywords were analyzed and visualized using the Bibliometrix package, WPS Office software, Microsoft PowerPoint 2019, VOSviewer software (version 1.6.18), ggplot2, and Scimago Graphica. RESULTS The development of the health economics of robotic surgery can be divided into three phases: slow-growing (2003-2009), developing (2010-2018), and fast-developing (2019-2022). J.C.H. and S.L.C. were the most active and influential authors, respectively. The USA produced the most documents, followed by China, and Italy. Korea had the highest number of citations per document. Surgical Endoscopy and Other Interventional Techniques accepted most documents, whereas Annals of Surgery, European Urology, and Journal of Minimally Invasive Gynecology had the highest number of citations per document. The Journal of Robotic Surgery is promising. The most-cited document in this field is New Technology and Health Care Costs - The Case of Robot-Assisted Surgery in 2010. The proportion of documents on urology is decreasing, while documents in the field of arthrology are emerging and flourishing. CONCLUSION Research on the health economics of robotic surgery has been unbalanced. Areas awaiting exploration have been identified. Collaboration between scholars and coverage with provisions for evidence development by the government is needed to learn more comprehensively about the health economics of robotic surgery.
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Affiliation(s)
- Yihao Peng
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Yuancheng Liu
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Sicen Lai
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Yixin Li
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Zexu Lin
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Lingjia Hao
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Jingyi Dong
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Xu Li
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Kai Huang
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
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12
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Li P, Meng C, Peng L, Gan L, Xie Y, Liu Y, Li Y. Perioperative comparison between robot-assisted and laparoscopic radical cystectomy: An update meta-analysis. Asian J Surg 2023; 46:3464-3479. [PMID: 37188592 DOI: 10.1016/j.asjsur.2023.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/01/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
We conducted this study to explore the efficacy and safety of laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BC).We searched the PubMed, Embase, Cochrane Library and Web of Science databases for studies on LRC and RARC treatment of BC from the time of the databases creation to May 1, 2022. We extracted data and used Stata 16.0 for calculation and statistical analyses.Thirteen studies with 1509 patients were included. Meta-analysis showed no statistically significant differences (P > 0.05) between RARC and LRC in terms of operative time (weighted mean difference [WMD] = 14.48; 95% confidence interval [CI][-2.49, 31.44], P = 0.001), estimated intraoperative blood loss (WMD = -4.23; 95% CI [-81.48, 73.01], P = 0.001), intraoperative blood transfusion (odds ratio [OR] = 0.7; 95% CI [0.39, 1.27]; P = 0.011), positive surgical margins (OR = 1.21; 95% CI [0.61, 2.03]; P = 0.855), time to regular diet, length of hospital stay (WMD = 0.37, 95% CI [-1.73, 2.46]; P = 0.001), postoperative hospital days (WMD = -0.52; 95% CI [-1.15, 0.11], P = 0.359), intraoperative complications, 30- day postoperative complications, and 90- day postoperative complications. However the RARC lymph node yield was higher than that of LRC (WMD = 1.87; 95% CI [0.74, 2.99], P = 0.147).Our study showed that LRC and RARC have similar efficacy and safety profiles for the treatment of muscle invasive bladder cancer.
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Affiliation(s)
- Pan Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China; Department of Urology, The People's Hospital of Pengan County, Pengan, 637800, Nanchong, Sichuan, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, 730000, China
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Ye Xie
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Yi Liu
- Department of Urology, The People's Hospital of Pengan County, Pengan, 637800, Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China.
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13
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Tappero S, Dell'Oglio P, Cerruto MA, Sanchez Salas R, Buisan Rueda O, Simone G, Hendricksen K, Soria F, Umari P, Antonelli A, Briganti A, Montorsi F, de Cobelli O, Terrone C, Galfano A, Moschini M, Di Trapani E. Ileal Conduit Versus Orthotopic Neobladder Urinary Diversion in Robot-assisted Radical Cystectomy: Results from a Multi-institutional Series. EUR UROL SUPPL 2023; 50:47-56. [PMID: 37101775 PMCID: PMC10123439 DOI: 10.1016/j.euros.2023.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
Background Head-to-head comparisons between ileal conduit (IC) and orthotopic neobladder (ONB) in terms of peri- and postoperative outcomes and complications, in the specific setting of robot-assisted radical cystectomy (RARC), are not available. Objective To address the impact of the type of urinary diversion (UD, IC vs ONB) on RARC morbidity, as well as operative time (OT), length of stay (LOS), and readmissions. Design setting and participants Urothelial bladder cancer patients treated with RARC at nine high-volume European institutions between 2008 and 2020 were identified. Intervention RARC with either IC or ONB. Outcome measurements and statistical analysis Intra- and postoperative complications were collected and reported according to the Intraoperative Complications Assessment and Reporting with Universal Standards recommendations and European Association of Urology guidelines, respectively. Multivariable logistic regression models tested the impact of UD on outcomes, after adjustment for clustering at single hospital level. Results and limitations Overall, 555 nonmetastatic RARC patients were identified. In 280 (51%) and 275 (49%) patients, an IC and an ONB were performed, respectively. Eighteen intraoperative complications were recorded. The rates of intraoperative complications were 4% in IC patients and 3% in ONB patients (p = 0.4). The median LOS and readmission rates were 10 versus 12 d (p < 0.001) and 20% versus 21% (p = 0.8) in IC versus ONB patients, respectively. At a multivariable logistic regression analyses, the type of UD (IC vs ONB) reached the independent predictor status for prolonged OT (odds ratio [OR]: 0.61, p = 0.03) and prolonged LOS (OR: 0.34, p < 0.001), but not for readmission (OR: 0.92, p = 0.7). Overall, 513 postoperative complications were experienced by 324 patients (58%). At least one postoperative complication was experienced by 160 (57%) IC patients versus 164 (60%) ONB patients (p = 0.6). The type of UD reached the status of an independent predictor of UD-related complications (OR: 0.64, p = 0.03). Conclusions Compared with RARC with ONB, RARC with IC is less prone to UD-related postoperative complications, prolonged OT, and prolonged LOS. Patient summary To date, the impact of the type of urinary diversion, namely, ileal conduit versus orthotopic neobladder, on peri- and postoperative outcomes of robot-assisted radical cystectomy is unknown. Based on a rigorous data accrual, which relied on established complication reporting systems (Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology recommended systems), we reported intra- and postoperative complications according to urinary diversion type. Moreover, we found that ileal conduit was associated with lower operative time and length of stay, and yielded a protective effect in terms of urinary diversion-related complications.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Corresponding author. Department of Urology, IRCCS Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. Tel. +39 3287132369, +39 0105553935.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology IRCCS, Milan, Italy
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14
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Huang C, Assel M, Beech BB, Benfante NE, Sjoberg DD, Touijer A, Coleman JA, Dalbagni G, Herr HW, Donat SM, Laudone VP, Vickers AJ, Bochner BH, Goh AC. Uretero-enteric stricture outcomes: secondary analysis of a randomised controlled trial comparing open versus robot-assisted radical cystectomy. BJU Int 2022; 130:809-814. [PMID: 35694836 PMCID: PMC10454986 DOI: 10.1111/bju.15825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyse the risk of uretero-enteric anastomotic stricture in patients randomised to open (ORC) or robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion. PATIENTS AND METHODS We included 118 patients randomised to RARC (n = 60) or ORC (n = 58) at a single, high-volume institution from March 2010 to April 2013. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher's exact test. RESULTS In all, 58 and 60 patients were randomised to RARC and ORC, respectively. We identified five strictures, all in the ORC group. In patients with ≥1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% confidence interval 1.5%, 17%). Of the five strictures, three were managed endoscopically while two required open revision. There was no evidence that perioperative Grade 3-5 complications were associated with development of a stricture (P = 1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (P = 0.15). CONCLUSIONS In this study at a high-volume centre, RARC with extracorporeal urinary diversion achieved excellent ureteric anastomotic outcomes. Purported increased risk of stricture is not a reason to avoid RARC. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed.
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Affiliation(s)
- Chun Huang
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Urology, Department of Surgery, University of Saskatchewan, Moose Jaw, SK, Canada
| | - Melissa Assel
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin B Beech
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole E Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adam Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sherri Machele Donat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vincent P Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Systems Drug Design for Muscle Invasive Bladder Cancer and Advanced Bladder Cancer by Genome-Wide Microarray Data and Deep Learning Method with Drug Design Specifications. Int J Mol Sci 2022; 23:ijms232213869. [PMID: 36430344 PMCID: PMC9692470 DOI: 10.3390/ijms232213869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Bladder cancer is the 10th most common cancer worldwide. Due to the lack of understanding of the oncogenic mechanisms between muscle-invasive bladder cancer (MIBC) and advanced bladder cancer (ABC) and the limitations of current treatments, novel therapeutic approaches are urgently needed. In this study, we utilized the systems biology method via genome-wide microarray data to explore the oncogenic mechanisms of MIBC and ABC to identify their respective drug targets for systems drug discovery. First, we constructed the candidate genome-wide genetic and epigenetic networks (GWGEN) through big data mining. Second, we applied the system identification and system order detection method to delete false positives in candidate GWGENs to obtain the real GWGENs of MIBC and ABC from their genome-wide microarray data. Third, we extracted the core GWGENs from the real GWGENs by selecting the significant proteins, genes and epigenetics via the principal network projection (PNP) method. Finally, we obtained the core signaling pathways from the corresponding core GWGEN through the annotations of the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway to investigate the carcinogenic mechanisms of MIBC and ABC. Based on the carcinogenic mechanisms, we selected the significant drug targets NFKB1, LEF1 and MYC for MIBC, and LEF1, MYC, NOTCH1 and FOXO1 for ABC. To design molecular drug combinations for MIBC and ABC, we employed a deep neural network (DNN)-based drug-target interaction (DTI) model with drug specifications. The DNN-based DTI model was trained by drug-target interaction databases to predict the candidate drugs for MIBC and ABC, respectively. Subsequently, the drug design specifications based on regulation ability, sensitivity and toxicity were employed as filter criteria for screening the potential drug combinations of Embelin and Obatoclax for MIBC, and Obatoclax, Entinostat and Imiquimod for ABC from their candidate drugs. In conclusion, we not only investigated the oncogenic mechanisms of MIBC and ABC, but also provided promising therapeutic options for MIBC and ABC, respectively.
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16
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Wang H, Huang H, Shang M, Hao H, Xi Z. Comparative Study of Perioperative and Oncological Outcomes Between Elderly Patients and Younger Patients Who Received Radical Cystectomy and Pelvic Lymph Node Dissection: A Single-Center Retrospective Study. Cancer Manag Res 2022; 14:603-613. [PMID: 35210857 PMCID: PMC8857955 DOI: 10.2147/cmar.s350587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the perioperative and survival outcomes of patients over 75 years and younger patients who received radical cystectomy. PATIENTS AND METHODS A total of 119 patients aged ≥75 years and 488 patients aged <75 years were enrolled. All patients underwent radical cystectomy with pelvic lymph node dissection. Clinical characteristics and perioperative outcomes were compared between the two groups. Overall survival and progression-free survival were analyzed by using the Kaplan-Meier method. Cox regression analysis and logistic regression analysis were used to identify the risk factors affecting the outcomes observed. RESULTS There was no significant difference in perioperative complications between the elderly patient group and the younger patient group (p = 0.349). The 5-year overall survival of elderly patients was lower than that of young patients (p < 0.001). Age ≥75 years was a risk factor for overall survival (HR = 1.69 [95% CI: 1.22-2.35]; p = 0.002) and progression-free survival (HR = 1.69 [95% CI: 1.14-2.50]; p = 0.008) for patients who received radical cystectomy but was not a poor risk factor for major complications (HR = 1.25 [95% CI: 0.47-3.31]; p = 0.658) after radical cystectomy. In addition, preoperative renal insufficiency was associated with a higher risk of major complications. CONCLUSION In our cohort, compared with younger patients, elderly patients aged ≥75 years had worse survival outcomes, but age ≥75 years was not a risk factor for major complications after radical cystectomy with pelvic lymph node dissection. Radical surgery should be encouraged for elderly patients who can tolerate aggressive treatments.
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Affiliation(s)
- Haixin Wang
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People’s Republic of China
- National Research Center for Genitourinary Oncology, Beijing, People’s Republic of China
- Department of Urology, Yankuang New Journey General Hospital, Zoucheng, Shandong, People’s Republic of China
| | - Haiwen Huang
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People’s Republic of China
- National Research Center for Genitourinary Oncology, Beijing, People’s Republic of China
| | - Meixia Shang
- Department of Medical Statistics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People’s Republic of China
- National Research Center for Genitourinary Oncology, Beijing, People’s Republic of China
| | - Zhijun Xi
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People’s Republic of China
- National Research Center for Genitourinary Oncology, Beijing, People’s Republic of China
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17
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Kobayashi T. Editorial Comment to Management of major venous bleeding during minimally invasive pelvic surgery: A proposed protocol for "What should we do next?". Int J Urol 2022; 29:179. [PMID: 34729820 DOI: 10.1111/iju.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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18
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Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center. Adv Urol 2021; 2021:4731013. [PMID: 34306069 PMCID: PMC8279872 DOI: 10.1155/2021/4731013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Laparoscopic radical cystectomy is a challenging surgical procedure; however, it has been largely abandoned in favor of the more intuitive robotic-assisted cystectomy. Due to the prohibitive cost of robotic surgery, the adoption of laparoscopic cystectomy is of relevance in low-resource institutes. Methodology. This is a randomized controlled trial comparing laparoscopic radical cystectomy (LRC) to open radical cystectomy (ORC) at a single institute. Each group included thirty patients. The trial was designed to compare both approaches regarding operative time, blood loss, transfusion requirements, length of hospital stay, time to oral intake, requirement of opioid analgesia, and complications. Results LRC was associated with less hospital stay (9.8 vs. 13.8 days, P=0.001), less time to oral solid intake (6 vs. 8.6 days, P=0.031), and lower opioid requirements (23.3% vs. 53.3%, P=0.033). There was a trend towards lower blood loss and transfusion requirements, but this did not reach statistical significance. Overall complication rates were comparable. Conclusion Laparoscopic radical cystectomy was associated with comparable postoperative outcomes when compared to ORC in the first laparoscopic cystectomy experience in our center. Benefitting from the assistance of an experienced laparoscopic surgeon is recommended to shorten the learning curve.
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19
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Zennami K, Sumitomo M, Takahara K, Nukaya T, Takenaka M, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Intra-corporeal robot-assisted versus open radical cystectomy: a propensity score-matched analysis comparing perioperative and long-term survival outcomes and recurrence patterns. Int J Clin Oncol 2021; 26:1514-1523. [PMID: 34009486 DOI: 10.1007/s10147-021-01939-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To compare perioperative and long-term oncological outcomes and recurrence patterns between robot-assisted radical cystectomy with intra-corporeal urinary diversion (iRARC) and open radical cystectomy (ORC). METHODS We retrospectively analyzed 177 bladder cancer patients who received iRARC or ORC at Fujita Health University between 2008 and 2020. Our primary endpoint was long-term oncological outcomes. As a secondary endpoint, we examined perioperative outcomes, complications, and recurrence patterns. These outcome measures were compared between the propensity score (PS)-matched cohorts. RESULTS PS-matched analysis resulted in 60 matched pairs from iRARC and ORC groups. The iRARC cohort was associated with significantly longer operative time (p = 0.02), lower estimated blood loss (p < 0.001), lower blood transfusion rate (p < 0.001), shorter length of hospital stay (p < 0.001), fewer overall complications (p = 0.03), and lower rate of postoperative ileus (p = 0.02). There was no statistically significant difference between iRARC and ORC in 5-year RFS (p = 0.46), CSS (p = 0.63), and OS (p = 0.71). RFS and CSS were also comparable, even in locally advanced (≥ cT3) disease. Multivariate analysis identified lymphovascular invasion as a robust predictor of RFS, CSS, and OS. The number of recurrence was similar between the groups, while extra-pelvic lymph nodes were more frequent in iRARC than that in ORC (22.7% vs. 7.7%). CONCLUSIONS iRARC has favorable perioperative outcomes, fewer complications, and comparable long-term survival outcomes, including locally advanced (≥ cT3) disease, compared to that in ORC. Our results need to be validated in prospective randomized clinical trials.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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20
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Shim JS, Noh TI, Ku JH, Lee S, Kwon TG, Kim TH, Jeon SH, Lee SH, Nam JK, Kim WS, Jeong BC, Lee JY, Hong SH, Rha KH, Han WK, Ham WS, Lee YG, Lee YS, Park SY, Yoon YE, Kang SG, Oh JJ, Kang SH. Effect of intraoperative fluid volume on postoperative ileus after robot-assisted radical cystectomy. Sci Rep 2021; 11:10522. [PMID: 34006918 PMCID: PMC8131600 DOI: 10.1038/s41598-021-89806-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/29/2021] [Indexed: 01/15/2023] Open
Abstract
This study aimed to investigate the effect of intraoperative fluid volume on the postoperative ileus (POI) recovery period. A retrospective review of the Korean robot-assisted radical cystectomy database identified 718 patients who underwent robot-assisted radical cystectomy (RARC). Regression analyses were performed to identify the associations between the amount of intraoperative fluid administration (crystalloid/colloid/total), POI period (time to flatus/bowel movements), and length of hospital stay (LOS) after adjusting for covariates. In addition, we analyzed the risk factors for gastrointestinal complications and prolonged POI using a logistic regression model. An increasing volume of the administered crystalloid/total fluid was associated with prolonged POI (crystalloid R2 = 0.0725 and P < 0.0001; total amount R2 = 0.0812 and P < 0.0001), and the total fluid volume was positively associated with the LOS (R2 = 0.099 and P < 0.0001). The crystalloid amount was a risk factor for prolonged POI (P < 0.001; odds ratio, 1.361; 95% confidence interval, 1.133–1.641; P < 0.001). In the context of RARC, increased intravenous fluids are associated with prolonged POI and longer LOS.
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Affiliation(s)
- Ji Sung Shim
- Department of Urology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Tae Il Noh
- Department of Urology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Hyup Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Wan Seok Kim
- Department of Urology, College of Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea. .,Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea.
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21
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Murthy PB, Lone Z, Munoz Lopez C, Ericson JZK, Thomas L, Caveney M, Gerber D, Khanna A, Abouassaly R, Haber GP, Lee BH. Comparison of Oncologic Outcomes Following Open and Robotic-assisted Radical Cystectomy with both Extracorporeal and Intracorporeal Urinary Diversion. Urology 2021; 154:184-190. [PMID: 33891929 DOI: 10.1016/j.urology.2021.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare oncologic endpoints between open radical cystectomy (ORC) and robotic-assisted radical cystectomy with extracorporeal urinary diversion (eRARC) or intracorporeal urinary diversion (iRARC). MATERIALS AND METHODS Retrospective review of all patients undergoing curative-intent radical cystectomy with urinary diversion for urothelial bladder cancer at a single-institution from 2010-2018. Primary outcomes included recurrence location and rates, recurrence-free (RFS) and overall survival (OS). Survival estimates were obtained using the Kaplan-Meier method and compared using log-rank analysis. Cox proportional-hazards model was used to identify predictors of survival. RESULTS 265, 366 and 285 patients underwent ORC, eRARC, and iRARC, respectively (n = 916). Median follow-up was 52, 40 and 37 months for ORC, eRARC and iRARC, respectively (P < 0.001). Ileal conduit was more commonly performed in iRARC (85%, P < 0.001). Neobladder rates did not vary. Neoadjuvant (p=0.4) or adjuvant therapy use (P = 0.36), pT-stage (P = 0.28) or pN-stage (P = 0.1) did not differ. Positive soft tissue margin rates were higher in ORC (7.2%-ORC, 3.6%-eRARC, 3.2%-iRARC, P = 0.041). Differences in recurrence rates or location were not observed. Surgical approach was not associated with any survival endpoint on proportional-hazards or Kaplan-Meier analysis. Hazard ratios and 95% CI for RFS were 1 (0.72-14) and 0.93 (0.66-1.3) for eRARC and iRARC, respectively, when compared to ORC as the referent. CONCLUSION These findings from a large, single-institution in conjunction with randomized-controlled trial data suggest that RARC does not compromise perioperative or long-term oncologic outcomes when compared to ORC.
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Affiliation(s)
- Prithvi B Murthy
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Zaeem Lone
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Carlos Munoz Lopez
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jj Zhang Kyle Ericson
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Lewis Thomas
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Maxx Caveney
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Gerber
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Abhinav Khanna
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Robert Abouassaly
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Georges-Pascal Haber
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Byron H Lee
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
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22
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Yu Z, Huang J, Deng H, Zeng Z, Deng L, Xu X, Chao H, Zeng T. A Novel Neobladder-Urethral Drag-and-Bond Anastomosis Technique During Laparoscopic Radical Cystectomy for Ileal Orthotopic Neobladder: Surgical Technique and Initial Research. Cancer Manag Res 2021; 13:2909-2915. [PMID: 33833574 PMCID: PMC8020451 DOI: 10.2147/cmar.s288673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the application of the neobladder-urethral drag-and-bond anastomosis technique in laparoscopic radical cystectomy (LRC) with ileal orthotopic neobladder (IONB) reconstruction. Patients and Methods This is a retrospective cohort study on a procedure performed by a single surgeon. From January 2014 to December 2018, we identified 43 male bladder cancer patients who received LRC with IONB reconstruction. These patients were divided into two groups, with 22 patients undergoing neobladder-urethral drag-and-bond anastomosis (NUDA) and 21 patients undergoing neobladder-urethral anastomosis under laparoscopy (NUAL). Anastomosis time, catheter removal time, postvoid residual (PVR), maximum urinary flow rate (Q-max), urine leakage and anastomotic stenosis were used to evaluate the simplicity and surgical effect of the two groups. Results Both groups demonstrated similar tumor characteristics. A significant difference in neobladder-urethral anastomosis time was found between the NUDA group and the NUAL group (14.6 ± 0.4 vs 70 ± 2.5 min, P<0.0001), and there was no significant difference in other characteristics. Conclusion The neobladder-urethral drag-and-bond anastomosis technique in LRC and IONB reconstruction, with its shorter learning curve, was easier and more convenient than neobladder-urethral anastomosis under laparoscopy.
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Affiliation(s)
- Zhaojun Yu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.,Department of Urology, The People's Hospital Affiliated to Nanchang University, Nanchang, 330006, People's Republic of China.,Medical Department, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Jianbiao Huang
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.,Department of Urology, The People's Hospital Affiliated to Nanchang University, Nanchang, 330006, People's Republic of China.,Medical Department, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Huanhuan Deng
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.,Medical Department, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Zhihua Zeng
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Leihong Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Xiangda Xu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Haichao Chao
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Tao Zeng
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
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23
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Huang H, Yan B, Hao H, Shang M, He Q, Liu L, Xi Z. Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis. Int J Urol 2021; 28:673-680. [PMID: 33714227 PMCID: PMC9291606 DOI: 10.1111/iju.14537] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To compare perioperative and oncologic survival outcomes between laparoscopic radical cystectomy and open radical cystectomy. METHODS A total of 607 patients underwent open radical cystectomy (n = 412) or laparoscopic radical cystectomy (n = 195) at a single academic institution from January 2006 to April 2017. Their medical records were retrospectively analyzed. One-to-one propensity score matching was carried out to reduce selection bias. Estimated blood loss and complications were compared. Overall survival, cancer-specific survival and progression-free survival estimates for all patients and patients with locally advanced bladder cancer were analyzed using the Kaplan-Meier method. RESULTS Either before or after matching, the laparoscopic radical cystectomy group had less estimated blood loss (P < 0.001 and P < 0.001) and fewer complications (P < 0.001 and P = 0.008). There was no difference in the overall survival (P = 0.216 and P = 0.961) and progression-free survival (P = 0.826 and P = 0.462) for all the patients having either laparoscopic radical cystectomy or open radical cystectomy. However, the 5-year progression-free survival of open radical cystectomy was higher than that of laparoscopic radical cystectomy (P = 0.019 and P = 0.021) for patients with locally advanced bladder cancer. CONCLUSIONS Laparoscopic radical cystectomy is superior to open radical cystectomy in terms of perioperative outcomes, and similar to open radical cystectomy in terms of oncologic outcomes for patients with early stage bladder cancer. However, for patients with locally advanced bladder cancer, laparoscopic radical cystectomy seems to be associated with shorter progression-free survival than open radical cystectomy.
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Affiliation(s)
- Haiwen Huang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Bing Yan
- Department of Urology, Xingtai People's Hospital, Xingtai, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Meixia Shang
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Libo Liu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Zhijun Xi
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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24
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Tan YG, Allen JC, Tay KJ, Huang HH, Lee LS. Benefits of robotic cystectomy compared with open cystectomy in an Enhanced Recovery After Surgery program: A propensity-matched analysis. Int J Urol 2020; 27:783-788. [PMID: 32632988 DOI: 10.1111/iju.14300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/28/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To compare the perioperative and oncological outcomes between robot-assisted radical cystectomy with intracorporeal urinary diversion versus open cystectomy for bladder cancer in a contemporary Enhanced Recovery After Surgery cohort. METHODS All consecutive patients who underwent radical cystectomy and managed under an Enhanced Recovery After Surgery protocol, from December 2013 to October 2018, were reviewed. Propensity score adjustment was carried out to reduce biases attributable to covariate imbalances. RESULTS There were 19 robot-assisted radical cystectomy with intracorporeal urinary diversion and 21 open cystectomy patients. The robot-assisted radical cystectomy with intracorporeal urinary diversion cohort was associated with lower estimated blood loss (397 vs 787 mL, P = 0.05), with a trend toward shorter duration of ileus and postoperative opioid administration. These benefits were apparent, despite a longer operative time (581 vs 446 mins, P = 0.03), a higher proportion of orthotopic bladder reconstruction (26.3 vs 9.5%, P = 0.08), a more prevalent use of neoadjuvant chemotherapy and a higher number of salvage cystectomies for the robot-assisted radical cystectomy with intracorporeal urinary diversion group. Comparable perioperative complications and length of hospital stay were observed. The pathological and intermediate oncological outcomes were similar in both groups (locally advanced disease: 52.6 vs 47.6%, P = 0.85; lymph node yield: 29 vs 34, P = 0.23). The mean recurrence-free survival and overall survival in the robot-assisted radical cystectomy with intracorporeal urinary diversion group was 37.5 and 43.0 months, respectively, compared with 21.4 (P = 0.09) and 35.5 (P = 0.14) months, respectively, in open cystectomy. CONCLUSION Robot-assisted radical cystectomy with intracorporeal urinary diversion has perioperative benefits of lower estimated blood loss, with a trend toward faster bowel recovery and a shorter duration of opioid analgesia when compared with open cystectomy. Robot-assisted radical cystectomy with intracorporeal urinary diversion also achieves similar intermediate-term oncological and survival outcomes.
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Affiliation(s)
- Yu Guang Tan
- Department of Urology, Sengkang General Hospital, Singapore
- Department of Urology, Singapore General Hospital, Singapore
| | - John Carson Allen
- Center for Quantitative Medicine/Office of Research, Duke-NUS Medical School, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore
- Department of Urology, Singapore General Hospital, Singapore
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25
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Mistretta FA, Luzzago S, Musi G, de Cobelli O. Minimally invasive versus open radical cystectomy: long term oncologic outcomes compared. Transl Androl Urol 2020; 9:1006-1008. [PMID: 32676384 PMCID: PMC7354333 DOI: 10.21037/tau-2020-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Haematology-Oncology, Università degli studi di Milano, Milan, Italy
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Nakane K, Enomoto T, Hishida S, Tomioka M, Taniguchi T, Kato D, Takai M, Iinuma K, Muramatsu Maekawa Y, Horie K, Mizutani K, Tsuchiya T, Yokoi S, Koie T. The Utility and Efficacy of Laparoscopic Radical Cystectomy in Patients with Muscle-Invasive Bladder Cancer at a Single Institution. Urol Int 2020; 104:573-579. [PMID: 32554972 DOI: 10.1159/000508192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to compare the surgical and oncological outcomes and complications of laparoscopic radical cystectomy (LRC) to those of open radical cystectomy (ORC) in patients with muscle-invasive bladder cancer (MIBC). METHODS Our study focused on patients with histologically confirmed stage T2-T4a urothelial carcinoma of the bladder without distant metastases, who underwent LRC (LRC group) or ORC (ORC group). The primary endpoints in this study were the overall survival (OS) and recurrence-free survival (RFS) rates. RESULTS In this study, 59 patients, 17 underwent LRC and 42 underwent ORC, were enrolled. The 2-year OS rate was 100% in the LRC group and 88.0% in the ORC group (p = 0.85). The 2-year RFS rate was 63.5% in the LRC group and 69.5% in the ORC group (p = 0.321). On multivariate analysis, the histological type, positive lymph node, and positive resection margin were significantly associated with the OS rates. CONCLUSIONS This study suggested that LRC may achieve similar oncological outcomes and fewer perioperative complications and less blood loss compared to ORC. Therefore, LRC should be considered as one of the treatment options for patients with MIBC.
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Affiliation(s)
- Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Torai Enomoto
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Seiji Hishida
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomoki Taniguchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | - Kengo Horie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kosuke Mizutani
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shigeaki Yokoi
- Department of Urology, Kizawa Memorial Hospital, Minokamo, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan,
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Shim JS, Kwon TG, Rha KH, Lee YG, Lee JY, Jeong BC, Pyun JH, Kang SG, Kang SH. Do patients benefit from total intracorporeal robotic radical cystectomy?: A comparative analysis with extracorporeal robotic radical cystectomy from a Korean multicenter study. Investig Clin Urol 2019; 61:11-18. [PMID: 31942458 PMCID: PMC6946824 DOI: 10.4111/icu.2020.61.1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aimed to compare complications, perioperative parameters, and oncologic outcomes between robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion (ECUD) and RARC with intracorporeal urinary diversion (ICUD). Materials and Methods Between 2007 and 2017, 362 patients who underwent RARC with ECUD or ICUD at multiple tertiary referral institutions were assessed. The primary endpoints were complication rates. The secondary outcomes were perioperative recovery parameters and oncological outcomes including estimated recurrence-free survival (RFS) and recurrence pattern between the 2 groups. Additionally, the complication rates of 2 expert surgeons with experience of >100 RARCs were analyzed. Results The ICUD group showed lower overall, gastrointestinal, and genitourinary complications (p=0.001, p=0.036, and p=0.036, respectively) than the ECUD group. Concerning perioperative outcomes, the ICUD group had a significantly longer operation time (p=0.002), although recovery parameters such as time to flatus passage, oral intake, and length of hospital stay were significantly shorter in this group (p=0.001, p<0.001, and p<0.001, respectively). There was no difference in oncologic outcomes such as positive margin rate (p=0.944) and 2-year RFS (p=0.496), and in the recurrence pattern between groups. In the comparison of the expert surgeons' complication rates, the major and total complication rates did not show differences (p=0.814 and p=0.102, respectively) while the minor complication rates were lower in the ICUD group (p=0.058). Conclusions This multi-institutional cohort study demonstrated the benefits of the ICUD approach, as indicated by lower complication rates and better recovery parameters, although the oncological results were similar to those of ECUD.
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Affiliation(s)
- Ji Sung Shim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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28
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Tae JH, Pyun JH, Shim JS, Cho S, Kang SG, Ko YH, Cheon J, Lee JG, Kang SH. Oncological and functional outcomes of robot-assisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve? Investig Clin Urol 2019; 60:463-471. [PMID: 31692995 PMCID: PMC6821988 DOI: 10.4111/icu.2019.60.6.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/04/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.
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Affiliation(s)
- Jong Hyun Tae
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Cheon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
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29
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Zamboni S, Soria F, Mathieu R, Xylinas E, Abufaraj M, D Andrea D, Tan WS, Kelly JD, Simone G, Gallucci M, Meraney A, Krishna S, Konety BR, Antonelli A, Simeone C, Baumeister P, Mattei A, Briganti A, Gallina A, Montorsi F, Rink M, Aziz A, Karakiewicz PI, Rouprêt M, Koupparis A, Scherr DS, Ploussard G, Sooriakumaran P, Shariat SF, Moschini M. Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration. BJU Int 2019; 124:656-664. [PMID: 31055865 DOI: 10.1111/bju.14791] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. MATERIALS AND METHODS We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. RESULTS Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. CONCLUSION The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
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Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Rennes University Hospital, Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - David D Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Simone
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Alessandro Antonelli
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | | | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Atiqullah Aziz
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Morgan Rouprêt
- GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | -
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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30
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Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup. J Urol 2019; 203:522-529. [PMID: 31549935 DOI: 10.1097/ju.0000000000000565] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The RAZOR (Randomized Open versus Robotic Cystectomy) trial revealed noninferior 2-year progression-free survival for robotic radical cystectomy. This update was performed with extended followup for 3 years to determine potential differences between the approaches. We also report 3-year overall survival and sought to identify factors predicting recurrence, and progression-free and overall survival. MATERIALS AND METHODS We analyzed the per protocol population of 302 patients from the RAZOR study. Cumulative recurrence was estimated using nonbladder cancer death as the competing risk event and the Gray test was applied to assess significance in differences. Progression-free survival and overall survival were estimated by the Kaplan-Meier method and compared with the log rank test. Predictors of outcomes were determined by Cox proportional hazard analysis. RESULTS Estimated progression-free survival at 36 months was 68.4% (95% CI 60.1-75.3) and 65.4% (95% CI 56.8-72.7) in the robotic and open groups, respectively (p=0.600). At 36 months overall survival was 73.9% (95% CI 65.5-80.5) and 68.5% (95% CI 59.8-75.7) in the robotic and open groups, respectively (p=0.334). There was no significant difference in the cumulative incidence rates of recurrence (p=0.802). Patient age greater than 70 years, poor performance status and major complications were significant predictors of 36-month progression-free survival. Stage and positive margins were significant predictors of recurrence, and progression-free and overall survival. Surgical approach was not a significant predictor of any outcome. CONCLUSIONS This analysis showed no difference in recurrence, 3-year progression-free survival or 3-year overall survival for robotic vs open radical cystectomy. It provides important prospective data on the oncologic efficacy of robotic radical cystectomy and high level data for patient counseling.
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黄 海, 闫 兵, 尚 美, 刘 漓, 郝 瀚, 席 志. [Propensity-matched comparison of laparoscopic and open radical cystectomy for female patients with bladder cancer]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:698-705. [PMID: 31420625 PMCID: PMC7433492 DOI: 10.19723/j.issn.1671-167x.2019.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the perioperative and oncologic outcomes of female patients receiving laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). METHODS Retrospective review of 91 consecutive female patients with urothelial carcinoma of bladder undergoing radical cystectomy at a single academic institution from 2006 to 2017. Those female patients received open radical cystectomy were matched to the patients who underwent laparoscopic radical cystectomy by using propensity score matching in 1 ∶1 ratio. The matching factors included age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, pathologic stage and pathologic nodal stage. The perioperation and oncology characteristics were compared, and Kaplan-Meier method was used to analyze the overall survival (OS), cancer specific survival (CSS) and progression-free survival (PFS) estimates. Finally, we did a sensitive analysis by using multivariable COX regression of all the patients, adjusting for the matching factors. RESULTS There were 65 ORC and 26 LRC patients identified in this cohort with urothelial carcinoma of bladder, the median follow-up time was 38 months (interquartile range 18-69). The age (P<0.001) and ASA scores (P=0.018) were less for LRC before being matched. There were 22 LRC and 22 ORC patients matching successfully. Before being matched, the estimate blood loss (P=0.005), transfusion rate (P<0.001) and total complications rate (P=0.015) were less for LRC, and the lymph nodes yield was greater for LRC, but there were no differences in OS (P=0.698), CSS (P=0.942) and PFS (P=0.837) between the two groups. After being matched, the estimate blood loss (P=0.009), transfusion rate (P=0.001) and total complications rate (P=0.040) were less for LRC, but there was no difference in the lymph nodes yield. Besides, there were no statistic differences in OS (P=0.432), CSS (P=0.429) and PFS (P=0.284) between the two groups. In addition, in multivariable COX regression analysis, surgical approaches (LRC/ORC) were not found to be a predictor of OS (HR 1.134, 95%CI 0.335-3.835, P=0.839), CSS (HR 1.051, 95%CI 0.234-4.719, P=0.949) and PFS (HR 0.538, 95%CI 0.138-2.095, P=0.371) of the female patients with urothelial carcinoma of bladder. CONCLUSION It is advantageous for laparoscopic radical cystectomy in terms of estimating blood loss, transfusion rate and complication rate. But there was no evidence that laparoscopic radical cystectomy for female patients with bladder cancer had a better oncologic prognosis than open radical cystectomy from this study.
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Affiliation(s)
- 海文 黄
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 兵 闫
- 邢台市人民医院泌尿外科,河北邢台 054001Department of Urology, Xingtai People’s Hospital, Xingtai 054001, Hebei, China
| | - 美霞 尚
- 北京大学第一医院医学统计室,北京 100034Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China
| | - 漓波 刘
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 瀚 郝
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - 志军 席
- 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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32
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Moschini M, Zamboni S, Soria F, Mathieu R, Xylinas E, Tan WS, Kelly JD, Simone G, Meraney A, Krishna S, Konety B, Mattei A, Baumeister P, Mordasini L, Montorsi F, Briganti A, Gallina A, Stabile A, Sanchez-Salas R, Cathelineau X, Rink M, Necchi A, Karakiewicz PI, Rouprêt M, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Lotan Y, Sooriakumaran P, Shariat SF. Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes. J Clin Med 2019; 8:jcm8081192. [PMID: 31395826 PMCID: PMC6722857 DOI: 10.3390/jcm8081192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Stefania Zamboni
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, 10124 Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Rennes University Hospital, 35000 Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, 75877 Paris, France
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT 06106, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Philipp Baumeister
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Armando Stabile
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H4A 3J1, Canada
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC H4A3J1, Canada
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10038, USA
| | | | - Stephen A Boorjian
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Prasanna Sooriakumaran
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10021, USA.
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Fujimura T. Current status and future perspective of robot-assisted radical cystectomy for invasive bladder cancer. Int J Urol 2019; 26:1033-1042. [PMID: 31364203 DOI: 10.1111/iju.14076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
The current status of robot-assisted radical cystectomy was reviewed 16 years after the initial robot-assisted radical cystectomy for the treatment of invasive bladder cancer. Articles associated with robot-assisted radical cystectomy and written in English were selected from the PubMed database from January 2003 to February 2019. The present review article focused on the distribution of robot-assisted radical cystectomy, patient selection, preoperative management, surgical technique, lymph node dissection, urinary diversion, recurrence pattern, oncological outcomes, cost, learning curve, complications and educational programs. A total of 400 articles were divided according to the country of the first author's affiliation. The USA was the most dominant at 198 (50%), whereas the number of articles from the countries belonging to the Urological Association of Asia was 15 (3.8%) for China, 17 (4.3%) for South Korea, 10 (2.5%) for Japan, eight (2%) for Taiwan, eight (2%) for Turkey and one (0.2%) for Iran. The percentage of robot-assisted radical cystectomy carried out is increasing, and intracorporeal urinary diversion and ileal neobladder are also frequently carried out. With a refined technique being performed in high-volume centers, robot-assisted radical cystectomy has contributed to the reduction in transfusion rate, length of stay and severe complications; however, it has not yet shown any cancer-specific survival benefits. Robot-assisted radical cystectomy is not fully spread throughout the Urological Association of Asia. Further investigation with respect to worldwide results is needed to prove the real benefit of robot-assisted radical cystectomy regarding low morbidity, reduced total medical cost, and survival benefit. In the era of precision medicine, appropriate drug and surgery will be given based on each genetic profile.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Influence of laparoscopic access in cancer-specific mortality of patients with pTa-2pN0R0 bladder cancer treated with radical cistectomy. Actas Urol Esp 2019; 43:241-247. [PMID: 30910257 DOI: 10.1016/j.acuro.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 11/10/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE Minimally invasive surgery represents an attractive surgical approach in radical cystectomy. However, its effect on the oncological results is still controversial due to the lack of definite analyses. The objective of this study is to evaluate the effect of the laparoscopic approach on cancer-specific mortality. MATERIAL AND METHOD A retrospective cohort study of two groups of patients in a pT0-2pN0R0 stage, undergoing open radical cystectomy (ORC) (n=191) and laparoscopic radical cystectomy (LRC) (n=74). Using Cox regression, an analysis has been carried out to identify the predictor variables in the first place, and consequently, the independent predictor variables related to survival. RESULTS 90.9% were males with a median age of 65years and a median follow-up period of 65.5 (IQR27.75-122) months. Patients with laparoscopic access presented a significantly higher ASA index (P=.0001), a longer time between TUR and cystectomy (P=.04), a lower rate of intraoperative transfusion (P=.0001), a lower pT stage (P=.002) and a lower incidence of infection associated with surgical wounds (P=.04). When analyzing the different risk factors associated with cancer-specific mortality, we only found the ORC approach (versus LRC) as an independent predictor of cancer-specific mortality (P=.007). Open approach to cystectomy multiplied the risk of mortality by 3.27. CONCLUSIONS In our series, the laparoscopic approach does not represent a risk factor compared to the open approach in pT0-2N0R0 patients.
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Lone Z, Hall S, Terakawa T, Ahmed YE, Elsayed AS, Aldhaam N, May PR, Miller A, Jing Z, Bragayrac LN, Khan H, Cohen J, Cole A, Rana O, Kanapan R, Prechtl C, Hussein AA, Guru KA. Accuracy of American College of Surgeons National Surgical Quality Improvement Program Universal Surgical Risk Calculator in Predicting Complications Following Robot-Assisted Radical Cystectomy at a National Comprehensive Cancer Center. J Endourol 2019; 33:383-388. [DOI: 10.1089/end.2019.0093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zaeem Lone
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Shelby Hall
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - Tomoaki Terakawa
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Youssef E. Ahmed
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ahmed S. Elsayed
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Naif Aldhaam
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Paul R. May
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Austin Miller
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Zhe Jing
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Luciano Nunez Bragayrac
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Hijab Khan
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jared Cohen
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Adam Cole
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Omer Rana
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Renuka Kanapan
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christian Prechtl
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ahmed A. Hussein
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Khurshid A. Guru
- A.T.L.A.S (Applied Technology Laboratory for Advanced Surgery) Program, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Moschini M, Soria F, Mathieu R, Xylinas E, D'Andrea D, Tan WS, Kelly JD, Simone G, Tuderti G, Meraney A, Krishna S, Konety B, Zamboni S, Baumeister P, Mattei A, Briganti A, Montorsi F, Galucci M, Rink M, Karakiewicz PI, Rouprêt M, Aziz A, Perry M, Rowe E, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Sooriakumaran P, Shariat SF. Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy. Urol Oncol 2019; 37:179.e1-179.e7. [DOI: 10.1016/j.urolonc.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/27/2022]
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Koie T, Ohyama C, Makiyama K, Shimazui T, Miyagawa T, Mizutani K, Tsuchiya T, Kato T, Nakane K. Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer. Int J Urol 2019; 26:334-340. [PMID: 30690817 PMCID: PMC6850512 DOI: 10.1111/iju.13900] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/09/2018] [Indexed: 01/06/2023]
Abstract
Radical cystectomy remains the gold standard for treatment of muscle‐invasive bladder cancer. Robot‐assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot‐assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high‐volume academic institutions. In the present review, we compare the totally intracorporeal robot‐assisted radical cystectomy approach with open radical cystectomy and robot‐assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle‐invasive bladder cancer patients.
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Affiliation(s)
- Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Clinical Education and Training Center, Faculty of Medicine, University of Tsukuba, Kasama, Ibaraki, Japan
| | - Tomoaki Miyagawa
- Depatment of Urology, Jichi Medical University Saitama Medical Center, Urawa, Saitama, Japan
| | - Kosuke Mizutani
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Taku Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
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Moudouni SM, Latabi AF, Aarab M, Lakmichi MA, Dahami Z, Sarf I. [Oncological results of a series of 93 laparoscopic radical cystectomies: 5 years of follow-up]. Prog Urol 2018; 29:86-94. [PMID: 30584022 DOI: 10.1016/j.purol.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report oncological results at 5 years after laparoscopic radical cystectomy (LRC) with lymph node dissection for bladder cancer (BC). PATIENTS AND METHODS This is a retrospective single-center study of all patients who underwent LRC for BC by the same surgeon from February 2007 to March 2016. Demographic, perioperative and oncologic data were collected. We reported overall survival rate (OS), cancer specific (CSS) and recurrence-free survival (SSR), as primary indicators of oncologycal outcomes. These survival rates were estimated according to the Kaplan-Meier method. Log-rank tests were used to explore overall survival according tumor stage, lymph node involvement and surgical margins status. RESULTS In all, 93 patients (82 men and 11 women) underwent LRC. Mean age was 59 years. Minor complications (Clavien I-II) occurred in 24.7%. Major complications (Clavien IIIa-V) were observed in 8.6%. No patients received neoadjuvant chemotherapy. Median lymph node (LN) yield was 15 and 26.5% patients had positive LN. The positive surgical margins (SMs) rate was 5.3%. Median follow-up for the entire patients was 50 months (19-84 months). Forty-three patients (46.2%) were followed for at least 71 months. Five year RFS, CSS and OS were 67%, 85% and 79%, respectively. Non organ confined desease, positive LN and positive SMs were associated with poorer OS (P<0.039, P<0.016 and P<0.001). CONCLUSION LRC was associated with acceptable long-term oncologic outcomes, similar to those currently reported after open cystectomy for BC. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- S M Moudouni
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - A F Latabi
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc.
| | - M Aarab
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - M A Lakmichi
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - Z Dahami
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - I Sarf
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
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Omar K, Gan C, Rottenberg G, O’Brien TS, Thomas K, Thurairaja R, Khan MS. A prospective study of the utility of a routine ‘loopogram’ at three months for the early detection of anastomotic stricture post-cystectomy and conduit urinary diversion. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817747475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: The objective of this study is to evaluate the utility of routine loopogram follow-up three months after cystectomy and urinary diversion in the early detection of benign ureteroileal anastomotic stricture (UAS). Materials and methods: A loopogram was incorporated into our standard follow-up three months after cystectomy and conduit urinary diversion in August 2010–December 2015. Data were maintained prospectively in a database. Results: A total of 250 patients (181 male; 69 female); median age of 70 years (range: 38–83) underwent cystectomy and conduit urinary diversion during this period. Of these, 167 (66.8%) had a routine loopogram at three months. Seven of 167 were confirmed to have a benign UAS. Twenty-three of 250 (9.2%) had an early loopogram prior to the planned three-month study in response to symptoms. Nine of 23 were diagnosed with benign UAS. Sixty of 250 (24%) did not have a routine loopogram for a variety of reasons. Five patients with normal three-month loopograms developed late strictures after a median time of 22 months (range 5–38). In total 21/250 (8.4%) patients developed UAS. Stricture rates for the open, robotic and laparoscopic modalities were 8/129 (6.2%), 12/111 (10.8%) and 1/10 (10%) respectively. Five of seven of patients with early, asymptomatic UAS diagnosed on routine loopogram received treatment; four of five had improvement in renal function. Conclusion: Overall stricture rate in this series was 8.4%. The majority of UAS occur early and are more likely to be symptomatic. A policy of routine loopogram benefitted only 4/250 (1.6%) patients. We advocate the use of loopograms in cases with a high index of suspicion rather than for routine screening. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Kawa Omar
- Guy’s and St Thomas’ NHS Foundation Trust, UK
| | | | | | | | - Kay Thomas
- Guy’s and St Thomas’ NHS Foundation Trust, UK
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40
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Xu Y, Pan F, Liu D, Yang X, Li S, Zhang Q, Li B. Laparoscopic radical cystectomy with intracorporeal ileal conduit diversion: Modified techniques and long-term outcomes. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yujie Xu
- Department of Urology, Union Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Feng Pan
- Department of Urology, Union Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Dong Liu
- Department of Urology, Shanghai Pudong Hospital; Fudan University Pudong Medical Center; Shanghai China
| | - Xiong Yang
- Department of Urology, Union Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Shuqiang Li
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Qijun Zhang
- Department of Urology, Union Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Kibel AS, Shemanski L, Pruthi RS, Montgomery JS, Weight CJ, Sharp DS, Chang SS, Cookson MS, Gupta GN, Gorbonos A, Uchio EM, Skinner E, Venkatramani V, Soodana-Prakash N, Kendrick K, Smith JA, Thompson IM. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 2018; 391:2525-2536. [PMID: 29976469 DOI: 10.1016/s0140-6736(18)30996-6] [Citation(s) in RCA: 507] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radical cystectomy is the surgical standard for invasive bladder cancer. Robot-assisted cystectomy has been proposed to provide similar oncological outcomes with lower morbidity. We aimed to compare progression-free survival in patients with bladder cancer treated with open cystectomy and robot-assisted cystectomy. METHODS The RAZOR study is a randomised, open-label, non-inferiority, phase 3 trial done in 15 medical centres in the USA. Eligible participants (aged ≥18 years) had biopsy-proven clinical stage T1-T4, N0-N1, M0 bladder cancer or refractory carcinoma in situ. Individuals who had previously had open abdominal or pelvic surgery, or who had any pre-existing health conditions that would preclude safe initiation or maintenance of pneumoperitoneum were excluded. Patients were centrally assigned (1:1) via a web-based system, with block randomisation by institution, stratified by type of urinary diversion, clinical T stage, and Eastern Cooperative Oncology Group performance status, to receive robot-assisted radical cystectomy or open radical cystectomy with extracorporeal urinary diversion. Treatment allocation was only masked from pathologists. The primary endpoint was 2-year progression-free survival, with non-inferiority established if the lower bound of the one-sided 97·5% CI for the treatment difference (robotic cystectomy minus open cystectomy) was greater than -15 percentage points. The primary analysis was done in the per-protocol population. Safety was assessed in the same population. This trial is registered with ClinicalTrials.gov, number NCT01157676. FINDINGS Between July 1, 2011, and Nov 18, 2014, 350 participants were randomly assigned to treatment. The intended treatment was robotic cystectomy in 176 patients and open cystectomy in 174 patients. 17 (10%) of 176 patients in the robotic cystectomy group did not have surgery and nine (5%) patients had a different surgery to that they were assigned. 21 (12%) of 174 patients in the open cystectomy group did not have surgery and one (1%) patient had robotic cystectomy instead of open cystectomy. Thus, 302 patients (150 in the robotic cystectomy group and 152 in the open cystectomy group) were included in the per-protocol analysis set. 2-year progression-free survival was 72·3% (95% CI 64·3 to 78·8) in the robotic cystectomy group and 71·6% (95% CI 63·6 to 78·2) in the open cystectomy group (difference 0·7%, 95% CI -9·6% to 10·9%; pnon-inferiority=0·001), indicating non-inferiority of robotic cystectomy. Adverse events occurred in 101 (67%) of 150 patients in the robotic cystectomy group and 105 (69%) of 152 patients in the open cystectomy group. The most common adverse events were urinary tract infection (53 [35%] in the robotic cystectomy group vs 39 [26%] in the open cystectomy group) and postoperative ileus (33 [22%] in the robotic cystectomy group vs 31 [20%] in the open cystectomy group). INTERPRETATION In patients with bladder cancer, robotic cystectomy was non-inferior to open cystectomy for 2-year progression-free survival. Increased adoption of robotic surgery in clinical practice should lead to future randomised trials to assess the true value of this surgical approach in patients with other cancer types. FUNDING National Institutes of Health National Cancer Institute.
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Affiliation(s)
- Dipen J Parekh
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Isildinha M Reis
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Biostatistics and Bioinformatics Shared Resource, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Erik P Castle
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - Mark L Gonzalgo
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Michael E Woods
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert S Svatek
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Tracey L Krupski
- Department of Urology, University of Virginia Health Science Center, Charlottesville, VA, USA
| | - Norm D Smith
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ahmad Shabsigh
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Atreya Dash
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Adam S Kibel
- Harvard Medical School, Boston, MA, USA; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - David S Sharp
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael S Cookson
- Department of Urology, Oklahoma University of Oklahoma, Norman, OK, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Edward M Uchio
- Department of Urology, University of California at Irvine, Irvine, CA, USA
| | - Eila Skinner
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Vivek Venkatramani
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nachiketh Soodana-Prakash
- Department of Urology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kerri Kendrick
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph A Smith
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian M Thompson
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; CHRISTUS Santa Rosa Medical Center Hospital, San Antonio, TX, USA
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İslamoğlu E, Anıl H, Erol İ, Taş S, Ateş M, Savaş M. Robotic radical cystectomy for the management of bladder cancer: Analysis of operative and pathological outcomes of eighteen patient. Turk J Urol 2018; 44:311-315. [PMID: 29932400 DOI: 10.5152/tud.2018.19577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/15/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the surgical and pathological results of robotic radical cystectomy (RRC) operations performed in our clinic. MATERIAL AND METHODS A total of 18 patients, who underwent RRC and intracorporeal urinary diversion between October 2016 and September 2017 for clinically localized bladder cancer in our clinic, were included in the study. The results were evaluated under three headings. 1. operative outcomes (total operation time, perioperative blood loss, postoperative hematocrit decrease) 2. recovery period (pull-off drain day, hospitalization time) 3. oncological results (pathologic stage, surgical margin, number, and characteristics of lymph nodes removed). Complications within the postoperative 30-day period, were evaluated and the Clavien classification system was used to classify the complications. RESULTS The mean age of the patients was 64.4 (52-80) years. Seventeen male patients and one female patient underwent robotic cystectomy. At the operative outcomes, the mean blood loss was 325 mL, and the mean hematocrit decrease was 3.15%. The mean duration of the surgery was 471 minutes (330-630), while the median operative time was 450 minutes. Complications occured in 6 patients during the early postoperative period. Six of them (75%) had minor complications (Clavien grade 1), two patients (25%) had major complications (Clavien grade 4). CONCLUSION Our initial experience with RRC is that, this surgical technique has acceptable operative, oncological and short-term clinical outcomes. However, prospective randomized studies are needed to assess whether there is a clear advantage compared to open surgery.
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Affiliation(s)
- Ekrem İslamoğlu
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hakan Anıl
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - İbrahim Erol
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Selim Taş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Savaş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Matsumoto K, Tabata KI, Hirayama T, Shimura S, Nishi M, Ishii D, Fujita T, Iwamura M. Robot-assisted laparoscopic radical cystectomy is a safe and effective procedure for patients with bladder cancer compared to laparoscopic and open surgery: Perioperative outcomes of a single-center experience. Asian J Surg 2017; 42:189-196. [PMID: 29254869 DOI: 10.1016/j.asjsur.2017.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/25/2017] [Accepted: 11/06/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We compared the perioperative outcomes of patients with bladder cancer according to three different procedures: robot-assisted laparoscopic radical cystectomy (RALC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC). METHODS From April 2008 to March 2017, 36 consecutive patients underwent radical cystectomy and ileal conduit with RALC (n = 10), LRC (n = 10), or ORC (n = 16). All patients underwent RALC and LRC with extracorporeal urinary diversion. Perioperative data were patient demographics, perioperative laboratory data including hematocrit and creatinine, intraoperative crystalloids and colloids, estimated blood loss (EBL), allogeneic transfusion, respiratory parameters including maximum end-tidal carbon dioxide (EtCO2) and respiratory rate, arterial blood gas data including highest pH, partial pressure of CO2 (PaCO2), partial pressure of oxygen (PaO2), operative time, opiate consumption including intraoperative and postoperative anesthesia, time of hospital stay, time to oral intake and normal diet, and adverse events. RESULTS EBL was less for RALC than for other procedures (p = 0.0004). No blood transfusions were performed for RALC, but ORC required significant blood transfusions (p = 0.003). Respiratory rate was highest and PaCO2 was lowest for RALC. Preoperative creatinine levels were significantly worse for the RALC group, but no significant differences were noted after surgery. There were no significant differences among the groups in regard to hematocrit levels. Operative time, laparoscopic time, intraoperative anesthesia, and postoperative anesthesia did not differ among the groups. High-grade adverse events were only seen for ORC. CONCLUSION Although RALC required a steep Trendelenburg position, which might add elements of risk, RALC was safe even for this small cohort.
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Affiliation(s)
- Kazumasa Matsumoto
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan.
| | - Ken-Ichi Tabata
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Takahiro Hirayama
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Soichiro Shimura
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Morihiro Nishi
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Daisuke Ishii
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Tetsuo Fujita
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Masatsugu Iwamura
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
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44
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Shim JS, Kwon TG, Rha KH, Lee YG, Lee JY, Jeong BC, Kim JY, Pyun JH, Kang SG, Kang SH. Oncologic Outcomes and Predictive Factors for Recurrence Following Robot-Assisted Radical Cystectomy for Urothelial Carcinoma: Multicenter Study from Korea. J Korean Med Sci 2017; 32:1662-1668. [PMID: 28875611 PMCID: PMC5592181 DOI: 10.3346/jkms.2017.32.10.1662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/01/2017] [Indexed: 11/24/2022] Open
Abstract
The aim of our study was to evaluate intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns in a multicenter series of patients treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma (UC) of the bladder. Between 2007 and 2015, 346 patients underwent RARC at multiple tertiary referral centers in Korea. Descriptive statistics were used for demographics and perioperative variables. Survival and recurrence were estimated with Kaplan-Meier analysis. Logistic regression models were used to determine predictors of recurrence. Median follow-up was 33 months (interquartile range [IQR], 7-50). The numbers of patients with organ-confined and lymph node (LN)-positive disease were 237 (68.4%) and 68 (19.7%), respectively. LN density (1-20 vs. > 20) was 13.6% and 6.1%, with a median of 17 nodes removed (IQR, 9-23). In logistic regression analysis, type of LN dissection, and pathologic tumor stage were significant predictors of cancer recurrence and death from cancer. Local, distal recurrence and secondary UC occurred in 7 (2.0%), 53 (15.3%), and 4 (1.2%) patients, respectively. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were 78%, 84%, and 73%, respectively. At last follow-up, RFS for extended pelvic LN dissection vs. standard pelvic LN dissection was 70% and 47% (P = 0.038). In addition, at last follow-up, LN density (0 vs. 1-20 vs. over 20) was 67%, 41%, and 29%, respectively (P < 0.001). Patients undergoing RARC in this multi-institutional cohort demonstrated intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns that were not unusual.
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Affiliation(s)
- Ji Sung Shim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ji Youl Lee
- Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea.
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Palazzetti A, Sanchez-Salas R, Capogrosso P, Barret E, Cathala N, Mombet A, Prapotnich D, Galiano M, Rozet F, Cathelineau X. Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy. Actas Urol Esp 2017; 41:416-425. [PMID: 27908634 DOI: 10.1016/j.acuro.2016.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Abstract
Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications.
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Affiliation(s)
- A Palazzetti
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia.
| | - P Capogrosso
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - E Barret
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - N Cathala
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - A Mombet
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - D Prapotnich
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - M Galiano
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - F Rozet
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
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Muto S, Kitamura K, Ieda T, Shimizu F, Nagata M, Isotani S, Ide H, Yamaguchi R, Horie S. A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: Initial experience. Investig Clin Urol 2017; 58:171-178. [PMID: 28480342 PMCID: PMC5419105 DOI: 10.4111/icu.2017.58.3.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/16/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Robot-assisted radical cystectomy (RARC) was originally intended to replace open radical cystectomy (ORC) as a minimally invasive surgery for patients with invasive bladder cancer. The purpose of this study was to evaluate the advantages of robotic surgery, comparing perioperative and oncologic outcomes between RARC and ORC. MATERIALS AND METHODS Between June 2012 and August 2016, 49 bladder cancer patients were given a radical cystectomy, 21 robotically and 28 by open procedure. We compared the clinical variables between the RARC and ORC groups. RESULTS In the RARC group, the median estimated blood loss (EBL) during cystectomy, total EBL, operative time during cystectomy, and total operative time were 0 mL, 457.5 mL, 199 minutes, and 561 minutes, respectively. EBL during cystectomy (p<0.001), total EBL (p<0.001), and operative time during cystectomy (p=0.003) in the RARC group were significantly lower compared with the ORC group. Time to resumption of a regular diet (p<0.001) and length of stay (p=0.017) were also significantly shorter compared with the ORC group. However, total operative time in the RARC group (median, 561 minutes) was significantly longer compared with the ORC group (median, 492.5 minutes; p=0.015). CONCLUSIONS This Japanese study presented evidence that RARC yields benefits in terms of BL and time to regular diet, while consuming greater total operative time. RARC may be a minimally invasive surgical alternative to ORC with less EBL and shorter length of stay.
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Affiliation(s)
- Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kousuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Ieda
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Raizo Yamaguchi
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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47
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Matulewicz RS, DeLancey JOL, Manjunath A, Tse J, Kundu SD, Meeks JJ. National comparison of oncologic quality indicators between open and robotic-assisted radical cystectomy. Urol Oncol 2016; 34:431.e9-431.e15. [DOI: 10.1016/j.urolonc.2016.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/10/2016] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
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Kim TH, Sung HH, Jeon HG, Seo SI, Jeon SS, Lee HM, Choi HY, Jeong BC. Oncological Outcomes in Patients Treated with Radical Cystectomy for Bladder Cancer: Comparison Between Open, Laparoscopic, and Robot-Assisted Approaches. J Endourol 2016; 30:783-91. [PMID: 27055782 DOI: 10.1089/end.2015.0652] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate oncological outcomes in patients with muscle-invasive bladder cancer who underwent open radical cystectomy (ORC), laparoscopic radical cystectomy (LRC), or robot-assisted radical cystectomy (RARC). PATIENTS AND METHODS A retrospective analysis was performed on 230 patients who underwent ORC (n = 150), LRC (n = 22), or RARC (n = 58) between September 2009 and June 2012. Perioperative outcomes were compared between the three surgical approaches. The influence of the type of surgical approach on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using the Kaplan-Meier method, and differences were assessed with the log-rank test. Predictors of RFS, CSS, and OS were also analyzed with a Cox regression model. RESULTS The median patient age for ORC, LRC, and RARC groups was 68.0 (interquartile range [IQR]: 60.0-73.0), 65.0 (IQR: 62.8-74.0), and 61.5 (IQR: 54.8-72.0) years, respectively (p = 0.017), and the median follow-up duration was 27.9 (IQR: 14.7-47.9), 28.8 (IQR: 15.7-41.8), and 32.0 (IQR: 15.5-45.4) months, respectively (p = 0.955). There was no significant difference in RFS, CSS, and OS according to the surgical approach (p = 0.253, p = 0.431, and p = 0.527, respectively). Subgroup analysis revealed that RFS, CSS, and OS were not significantly different in both subgroups with stage ≤pT2 or ≥pT3. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of RFS, CSS, and OS. CONCLUSION Our findings indicate that the type of surgical approach is not associated with RFS, CSS, and OS in patients with bladder cancer.
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Affiliation(s)
- Tae Heon Kim
- 1 Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon, Republic of Korea
| | - Hyun Hwan Sung
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Hwang Gyun Jeon
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Seong Il Seo
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Seong Soo Jeon
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Hyun Moo Lee
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Han Yong Choi
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Byong Chang Jeong
- 2 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
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Sanli O, Tefik T, Erdem S, Ortac M, Salabas E, Karakus S, Yucel B, Boyuk A, Oktar T, Ozcan F, Aras N, Tunc M, Nane I. Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years. J Minim Access Surg 2016; 12:33-40. [PMID: 26917917 PMCID: PMC4746972 DOI: 10.4103/0972-9941.158154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM: To evaluate the laparoscopic operations performed in our department according to the modified Clavien classification system of complications. MATERIALS AND METHODS: Between September, 2005 and February, 2014, a total of 1023 laparoscopic cases were performed. This period was divided into three terms (Terms 1, 2 and 3 consisting of 38, 32 and 32 months, respectively). According to the European Scoring System (ESS), easy (E), slightly difficult (SD), fairly difficult (FD), difficult (D), very difficult (VD) and extremely difficult (ED) cases were 35, 88, 170, 390, 203 and 137, respectively. The perioperative complications were evaluated based on the 3 time periods, with a specific emphasis on determining the learning curve according to the modified Clavien classification system of complications. RESULTS: A total of 236 (23.1%) complications were observed according to the modified Clavien classification. The minor (Clavien I-II) and major (Clavien III, IV and V) complication rates were 20.5% (n = 210) and 2.4% (n = 26), respectively. Clavien I was the most frequently encountered type of complication (n = 120, %11.7). No significant difference was observed among all 3 time periods regarding total complication rates. The D cases had the highest complication rate compared to E, SD, FD, VD and ED cases among all three terms. The total number of complications increased significantly with increasing grade of technical difficulty according to the ESS. CONCLUSION: Complications encountered in our laparoscopic surgery experience were predominantly minor, and the rate of complications was not significantly increased during the learning curve. The present data can provide guidance and manage expectations for surgeons introducing laparoscopy into their practice.
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Affiliation(s)
- Oner Sanli
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mazhar Ortac
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Salabas
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Karakus
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Yucel
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abubekir Boyuk
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tayfun Oktar
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Necdet Aras
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Tunc
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismet Nane
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Hayakawa N, Kikuno N, Ishihara H, Ryoji O, Tanabe K. Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience. SPRINGERPLUS 2015; 4:401. [PMID: 26261759 PMCID: PMC4529429 DOI: 10.1186/s40064-015-1200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
Purpose Decision making regarding the urethra before and after radical cystectomy due to urothelial carcinoma has always been controversial. To determine whether anterior urethra sparing cystoprostatectomy for bladder cancer is an oncologically-safe procedure, we evaluated the long-term oncologic clinical outcome. Patients and methods A total of 51 male patients with cTa-4N0-2M0 bladder cancer were treated with anterior urethra sparing cystoprostatectomy and simultaneous urinary diversion between 2000 and 2013, and underwent follow up for 4 months or more. We assessed differences in the perioperative outcomes, oncologic outcomes and recurrence rates according to the urinary diversion. Results The median patient age and follow-up period were 66 years and 35 months, respectively. The 5- and 10-year recurrence free survival (RFS) rates in ileal conduit (IC) group vs. orthotopic neobladder reconstruction (NB) group were 45.0 and 20.3% vs. 39.3 and 19.6%, respectively. Likewise, the 5- and 10-year disease specific survival (DSS) were 52.7 and 32.1% vs. 39.3 and 29.5%, respectively. Multivariate analysis revealed two independent prognostic factors for RFS and DSS, including age at surgery and lymph node status. Local recurrence in the remnant anterior urethra occurred in only 1 patient (2.0%) at 57 months after surgery. Conclusions Our long-term data show that anterior urethra sparing cystoprostatectomy is an oncologically-safe procedure regardless of the type of urinary diversion in a subset of carefully selected patients with bladder cancer without evidence of urothelial carcinoma in the urethra/bladder neck and urethral surgical margin. Electronic supplementary material The online version of this article (doi:10.1186/s40064-015-1200-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Nobuyuki Kikuno
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Osamu Ryoji
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
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