Age ≥ 80 years is independently associated with survival outcomes after radical cystectomy: Results from the Canadian Bladder Cancer Network Database

Fairey, Adrian; Kassouf, Wassim; Aprikian, Armen; Chin, J.; Izawa, J.; Fradet, Yves; Lacombe, Louis; Rendon, Ricardo; Bell, David; Cagiannos, Ilias; Drachenberg, Darrel; Lattouf, Jean‐Baptiste; Estey, Eric

doi:10.1016/j.urolonc.2011.07.014

Cited by 31 publications

(19 citation statements)

References 16 publications

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“…After removing the epidural catheter after 72 hours, oral medication proved sufficient (NAS max. [3][4].…”

Section: Resultsmentioning

confidence: 99%

“…Data from meta-analyses show that through a neuroaxial blockade, a decreased mortality rate of 30% can be reached while the morbidity rate is considerably reduced. This is achieved with a decreased incidence of deep venous thrombosis, pulmonary embolism, myocardial infarction, transfusions, pneumonias, infections, respiratory depression and liver failure (4,6,7). Secondly, it is generally known that dispensing with general anesthesia leads to a clear relief of the cardiopulmonary system, from which particularly patients with increased cardiopulmonary risks benefit.…”

Section: Discussionmentioning

confidence: 99%

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Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: To assess the feasibility and performance of radical cystectomy with urinary diversion using exclusively regional anesthesia (i.e. combined spinal thoracic epidural anesthesia, CSTEA). Materials and Methods:In 2011 radical cystectomy with extended pelvic and iliac lymphadenectomy was performed on 14 patients using urinary diversion without applying general anesthesia. Under maintained spontaneous breathing, the patients were awake and responsive during the entire procedure. Postoperatively, pain management took three days with the remaining epidural catheter before oral analgesics were administered. Mobilization and diet restoration were carried out according to the fast-track concept. Outcome measurements included operative time, blood loss, beginning of oral nutrition, beginning of mobilization, postoperative pain levels using numerical and visual analog scales (NAS/VAS), length of hospital stay. Results: All surgical procedures were performed without any complications. The absence of general anesthesia did not result in any relevant disadvantages. The postoperative progress was normal in all patients. Particularly, cardiopulmonary complications and enteroparesis did not occur. The provided palliative care proved sufficient (NAS max. 3-4). Discharge followed 10 to 22 days after surgery. At the time of discharge, the patients described the procedure to be relatively positive. Conclusions: Our data show that CSTEA is an effective technique for radical cystectomy, whereby spontaneous breathing and reduced interference with the cardiopulmonary system potentially lower the perioperative risks especially for high-risk patients. We recommend practice of CSTEA for radical cystectomy to further evaluate and monitor the safety, efficacy, outcomes, and complications of CSTEA.

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“…After removing the epidural catheter after 72 hours, oral medication proved sufficient (NAS max. [3][4].…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

et al. 2012

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show abstract

“…Data from meta-analyses show that through a neuraxial blockade, a decreased mortality rate of 30% can be reached while the morbidity rate is considerably reduced. This is achieved with a decreased incidence of deep venous thrombosis, pulmonary embolism, myocardial infarction, transfusions, pneumonias, infections, respiratory depression and liver failure [4,7,8]. Second, it is generally known that dispensing with general anesthesia leads to a clear relief of the cardiopulmonary system, from which particularly patients with increased cardiopulmonary risks benefit.…”

Section: Discussionmentioning

confidence: 99%

“…The morbidity and mortality rates of radical cystectomy with urinary diversion are caused by patient-specific, anesthesiological and surgical factors (individual patient risk profile, selection and administration of the anesthesiological procedure, extension of the procedure, spread or metastasis of the bladder cancer, type of urinary diversion, surgical expertise, frequency of operations). The perioperative mortality rate of radical cystectomy is between 2.9 and 7.7% [1,2,3,4]. The perioperative morbidity rate is between 11 and 68% [3].…”

Section: Introductionmentioning

confidence: 99%

Performing Radical Cystectomy and Urinary Diversion in Regional Anesthesia: Potential Risk Reduction in the Treatment of Bladder Cancer

et al. 2013

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Objective: To assess the feasibility and performance of radical cystectomy with urinary diversion using exclusively regional anesthesia (i.e. combined spinal thoracic epidural anesthesia, CSTEA), avoiding the adverse effects of general anesthesia. Materials and Methods: In our hospital, radical cystectomy with extended pelvic and iliac lymphadenectomy and urinary diversion was performed on 28 patients using CSTEA without applying general anesthesia, in 2011 and 2012. Under maintained spontaneous breathing, the patients were awake and responsive during the entire procedure. Outcome measurements included operative time, blood loss, start of oral nutrition, start of mobilization, postoperative pain levels using numerical and visual analog scales (NAS/VAS), postoperative complications according to the Clavien-Dindo classification and length of hospital stay. Results: All surgical procedures were performed without any complications and caused no anesthesiologically or surgically untoward effects. We observed no more severe complications than grade 1 according to the Clavien-Dindo classification. Conclusions: Our data show that CSTEA is an effective and safe technique for radical cystectomy, whereby spontaneous breathing and reduced interference with the cardiopulmonary system potentially lower the perioperative risks, especially for high-risk patients. We recommend practice of CSTEA for radical cystectomy to further evaluate and monitor the safety, efficacy, outcomes and complications of CSTEA.

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“…12 Chemoradiotherapy is thus a viable alternative to neoadjuvant chemotherapyradical cystectomy, and this is particularly relevant for the rapidly growing proportion of over 80-year-old patients diagnosed with MIBC, 9 for whom the 90-day mortality rates for radical cystectomy are significantly greater than those for younger patients. 26 In reality, data demonstrate that the majority of over 80-year-old patients diagnosed with MIBC in the UK are treated with radiotherapy, although experts consider that cystectomy in this group is safe when carried out in selected patients in specialist high-volume units, and utilising enhanced recovery programmes.…”

Section: Treatment Of Mibcmentioning

confidence: 99%

Update on bladder cancer diagnosis and management

Bryan

2013

Trends Urol & Men's Health

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Age ≥ 80 years is independently associated with survival outcomes after radical cystectomy: Results from the Canadian Bladder Cancer Network Database

Cited by 31 publications

References 16 publications

Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

Performing Radical Cystectomy and Urinary Diversion in Regional Anesthesia: Potential Risk Reduction in the Treatment of Bladder Cancer

Update on bladder cancer diagnosis and management

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