Incidence and Risk Factors of 30-Day Early and 90-Day Late Morbidity and Mortality of Radical Cystectomy During a 13-Year Follow-up: A Comparative Propensity-score Matched Analysis of Complications Between Neobladder and Ileal Conduit

Kim, Sung-Han; Yu, Ami; Jung, Jae Hyun; Lee, Young Ju; Lee, Eunsik

doi:10.1093/jjco/hyu051

Cited by 31 publications

(18 citation statements)

References 29 publications

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“…This is at odds with the findings reported by Kim et al [26] , who used propensity-score matching to analyze retrospective data from 308 patients with nonmetastatic bladder cancer following RC with either ileal conduit or neobladder, over a period of 13 years. The type of urinary diversion was found not to represent a significant risk factor for early or late morbidities [26] .…”

Section: Discussionmentioning

confidence: 74%

90-Day Mortality after Radical Cystectomy for Bladder Cancer: Prognostic Factors in a Multicenter Case Series

D’Elia

Comploj²,

Cerruto³

et al. 2016

Urol Int

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Objectives: To identify preoperative risk factors for 90-day mortality and to validate existing nomograms in a multicenter series of patients undergoing radical cystectomy (RC). Materials and Methods: We evaluated 90-day mortality in 475 patients following RC and urinary diversion at 2 Italian institutions and validated Aziz and Isbarn nomogram. Univariable logistic models assessed the predictive ability of operative volume, age at intervention, gender, body mass index, carcinoma in situ at transurethral resection of the bladder, American Society of Anesthesiologist (ASA) score, Charlson Comorbidity Index, clinical stage and pathological stage (TNM). Results: Of the total number of patients, 387 of them (81%) were male. The median age at RC was 71.8. The most frequent ASA score was 2 (53%). Twenty-five deaths occurred within 90 days (5.3%), all among patients who had undergone RC and incontinent urinary diversion. Risk was higher in patients with advanced disease (OR 2.4); moreover, 90-day mortality odd in 70-79-year-old patients was 13 times higher than those of younger patients (<70). Predictive accuracy using Isbarn's and Aziz's nomogram were 67 and 71%, respectively. Conclusions: Our multicenter study confirmed the moderate predictive value of the Aziz nomogram. Larger studies are needed to improve on existing nomograms with the aim of enhancing preoperative counseling.

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Section: Discussionmentioning

confidence: 74%

90-Day Mortality after Radical Cystectomy for Bladder Cancer: Prognostic Factors in a Multicenter Case Series

D’Elia

Comploj²,

Cerruto³

et al. 2016

Urol Int

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“…Controlling the complications of ileal neobladder surgery is a critical issue that needs to be addressed as it greatly affects the QoL of patients. Previous studies have shown that the complication rate of ileal neobladder surgery following radical cystectomy was as high as 28-58% [9][10][11]. A follow-up of 5 years was performed in the present study.…”

Section: Discussionmentioning

confidence: 77%

Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation

et al. 2019

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Purpose The purpose of this study was to analyze long-term complications, urodynamics, and quality of life (QoL) of patients after orthotopic ileal neobladder with orthotopic ureteral reimplantation to enrich clinical data and provide a basis for clinical use of this surgery. Methods Between January 2007 and January 2013, 72 consecutive patients who underwent spiral ileal neobladder following radical cystectomy were enrolled. The neobladder was created using a modified Camey-II technique. Complications were reviewed and staged according to Clavien-Dindo classification and evaluated in long-term follow-up. Urodynamics were performed, and QoL was assessed by the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL) instrument. Results The total follow-up time was 60 months, and the total survival rates at 3 and 5 years after surgery were 76.4% (55/72) and 65.3% (47/72), respectively. There were 34 (47.2%) early complications in 23 (31.9%) patients and 42 (58.3%) late complications in 35 (48.6%) patients. The total satisfactory control rates were 69.1% and 66.0% at 3 and 5 years after the surgery, respectively. Urodynamic studies were performed in some patients, and the receiver operating characteristic curve analysis showed that pressure at maximum capacity, compliance, and post void residual urine had predictive value for mortality (P < 0.05). The total FACT-BL scores of patients at 1, 3, and 5 years postoperation were 125.0 ± 15.2, 127.0 ± 16.2, and 120.6 ± 13.5, respectively, and it decreased at 5 years postoperation (P < 0.05). Conclusion Spiral ileal neobladder with orthotopic ureteral reimplantation offers satisfactory long-term results, and urodynamic monitoring might have prognostic value.

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“…It was noted that the type of diversion significantly affected the late complications with a higher incidence in the neobladder group but not the early complications. They also discovered that hypertension and the number of lymph nodes removed were independent risk factors for both early and late complications [25].…”

Section: Discussionmentioning

confidence: 99%

Urinary Diversion in the Elderly

Ayoub

Westney

2015

Curr Bladder Dysfunct Rep

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The elderly or older population segment has a heterogenous definition in the literature with the majority including patients aged between 60 and 80 years. Several studies have proven that a cystectomy can be performed safely in the elderly population. We sought out to review the literature identifying the specific complications and the considerations requiring attention when performing a urinary diversion on an elderly patient. A review of literature performed using PubMed revealed paucity of citations specifically looking at different urinary diversion techniques and the specific complications related in an elderly population. However, we extrapolated additional data from articles that studied cystectomy surgical cohorts with identifiable age stratification. Particular complications and areas deserving of additional attention included gastrointestinal, renal, ureteroenteric anastomotic technique, metabolic disorders, quality of life, and voiding dysfunction. Detailed history and proper counseling of the patient and family are central to the selection of the appropriate urinary diversion technique and help maintain realistic patient expectations with a higher satisfaction rate. It is of paramount importance when considering continent urinary diversions to address the feasibility of adhering to a higher level of maintenance and the patient's ability to withstand diversionrelated complications.

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Incidence and Risk Factors of 30-Day Early and 90-Day Late Morbidity and Mortality of Radical Cystectomy During a 13-Year Follow-up: A Comparative Propensity-score Matched Analysis of Complications Between Neobladder and Ileal Conduit

Cited by 31 publications

References 29 publications

90-Day Mortality after Radical Cystectomy for Bladder Cancer: Prognostic Factors in a Multicenter Case Series

90-Day Mortality after Radical Cystectomy for Bladder Cancer: Prognostic Factors in a Multicenter Case Series

Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation

Urinary Diversion in the Elderly

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