Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases

Mitra, Anirban P.; Cai, Jie; Miranda, Gus; Bhanvadia, Sumeet; Quinn, David I.; Schuckman, Anne; Djaladat, Hooman; Daneshmand, Siamak

doi:10.1097/ju.0000000000002242

Cited by 45 publications

(31 citation statements)

References 31 publications

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“…Current rates for continent UD in females range around 4-15% (65,(69)(70)(71). Across all patients with bladder cancer, there has been a decreasing use of ONB reconstruction (10-30%), with only single centers exceeding this range (63)(64)(65)69,72,73). This trend does not dependent on the surgical approach [ORC vs. RARC ± intracorporeal UD (ICUD)].…”

Section: Udmentioning

confidence: 99%

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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Background and Objective: Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women.Methods: We performed a non-systematic literature review of the available publications in the PubMed database.

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Section: Udmentioning

confidence: 99%

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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“…Recent reports described the efficacy of NAC in bladder cancer [38,39], with the number of cases strongly increasing. However, whether all patients with MIBC should receive NAC is controversial [40]. Therefore, identifying patients that have a poor prognosis for induction treatment is important for determining treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis

et al. 2022

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Introduction: This study had two objectives: (i) to evaluate oncological outcomes in a long-term follow-up of patients with bladder cancer after reduced-port laparoscopic radical cystectomy (RP-LRC) and (ii) to assess the effect of modified Glasgow prognostic scores (mGPS) on patient outcomes. Methods: Consecutive patients (n = 100) who received RP-LRC between March 2012 and December 2018 at our institution and affiliated hospital were retrospectively reviewed. Preoperative serum albumin and C-reactive protein levels were determined. Patients were grouped based on clinical T stage (≤cT2: n = 75, ≥cT3: n = 25) using pooled cumulative data. Oncological outcomes and mGPS as a prognostic biomarker were analyzed retrospectively. Kaplan-Meier curves displayed recurrence and survival rates. Univariate and multivariate Cox regression analyses evaluated potential prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Patient characteristics between the two groups were statistically similar for preoperative hematological and mGPS status, blood loss level, rate of allogeneic transfusion, and pneumoperitoneum time. After a median follow-up period of 55 months, 40/100 patients experienced disease relapse. RFS and CSS for ≤cT2 were significantly less than for ≥cT3 (p < 0.001, p < 0.05, respectively). Distant metastasis occurred in 30 patients with similar distributions of relapse sites between T-stage cohorts. Median RFS for mGPS 1/2 were 18.9 (95% confidence interval [CI]: 8.8–not assessed [NA]) and 35.0 (95% CI: 8.7–NA) months, respectively, significantly worse than for mGPS 0 (median NA, 95% CI: NA–NA); CSS was similar. Univariate and multivariate analyses revealed ≥cT3 stage, worse clinical N stage, and poor mGPS status were significant prognostic factors for short RFS and CSS. Conclusions: A large proportion of bladder cancer patients who undergo RP-LRC experience relapse, with ≥cT3 stage, worse clinical N stage or poor mGPS status identified as significant prognostic factors. Our findings may contribute to improved surgical procedures for such patients.

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“…In contrast to the national trend, up to 75% of patients receive orthotopic reconstruction in pioneering institutions [3]. A recent study from University of Southern California (USC) showed that despite higher percentage of older patients with more comorbidities in the last decade, 59.6% of patients underwent orthotopic neobladder during open RC [4 ▪ ]. According to the contemporary data, most patients undergoing RC are candidates for orthotopic urinary diversion except for those with renal dysfunction (glomerular filtration rate: GFR < 40 ml/min), impaired external sphincter, comorbidities affecting manual dexterity or unwillingness to perform self-catheterization, and positive intraoperative urethral margins [5].…”

Section: Introductionmentioning

confidence: 99%

Comparative performance of the different orthotopic urinary diversions

Moghaddam

Ghoreifi

Djaladat

2022

Current Opinion in Urology

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Purpose of reviewMajority of patients undergoing radical cystectomy are suitable for orthotopic urinary diversion. The effect of different techniques of neobladder reconstruction on early and long-term postoperative complications is still being determined. Additionally, it is unclear which type of neobladder provides the best patient satisfaction. The purpose of this article is to review the outcomes of different orthotopic urinary diversions following radical cystectomy.Recent findingsIleal neobladder is the preferred type of orthotopic urinary diversion following radical cystectomy. Hautmann and Studer, which are the most common orthotopic diversion techniques, provide daytime continence rate up to 87% and 92%, respectively. However, nighttime continence is achieved in about 50% of patients. High-level evidence supports the long-term safety of orthotopic neobladder in terms of renal function, even in patients with a glomerular filtration rate <60 ml/min. Sexual dysfunction is the only independent factor associated with poorer quality of life in these patients.SummaryThe best type of neobladder is still uncertain. However, Studer and Hautmann are the most commonly performed techniques that provide favorable short- and long-term outcomes.

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Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases

Cited by 45 publications

References 31 publications

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis

Comparative performance of the different orthotopic urinary diversions

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