Radical cystectomy in patients with disseminated disease: An assessment of perioperative outcomes using the National Surgical Quality Improvement Program database

Abstract

Introduction: We sought to determine the effect of the presence of disseminated disease on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 4108 eligible patients who underwent radical cystectomy for bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We matched patients with disseminated cancer at the time of surgery to those without disseminated cancer using propensity scores. The primary outcome of interest was major complications (death, reoperation, cardiac or neurological event). Secondary outcomes included pulmonary, infectious thromboembolic, and bleeding complications, in addition to prolonged length of stay. Generalized estimating equations were used to examine the association between disseminated cancer and the development of complications. Results: Following propensity score matching and adjusting for the type of urinary diversion, radical cystectomy in patients with disseminated disease was associated with a significant increase in major complications (8.6% vs. 4.0%; odds ratio [OR] 2.50; 95% confidence interval [CI] 1.02-6.11; p=0.045). The presence of disseminated disease was associated with an increase in pulmonary complications (5.8% vs. 1.2%; OR 5.17. 95% CI 1.00-26.66. p=0.049), but not infectious complications, venous thromboembolism, bleeding requiring transfusion, and prolonged length of stay (p values 0.07-0.79). Conclusions: Patients with disseminated cancer undergoing cystectomy are more likely to experience major and pulmonary complications. The strength of these conclusions is limited by sample size, selection bias inherent in observational data, and a lack of specific oncological detail in the database.

Venous Thromboembolism Rate in Patients with Bladder Cancer According to the Type of Treatment: A systematic review

“…In our current review, the data from three studies that followed up the patients for three months after cystectomy revealed that VTE rates were still high; this may be due to patients having further treatment and hospitalisation [15,18,50]. According to the study by , the VTE rate peaks at 20 days after cystectomy in BC patients; however, patients continue to be at risk of VTE long after surgery [16]. As found in this review, BC patients who had undergone cystectomy have an elevated risk of VTE for up to three months after surgery [13].…”

“…There are many possible explanations for the large variations in the rates of VTE observed within this group: for example, the heterogeneity of risk factors in this population that could affect the rate of VTE such as minimal invasive (robotic) cystectomy or open radical cystectomy [10]. Additionally, 33 of the included studies did not state, discuss or categorise BC patients according to confounding factors that alter the rate of VTE such as receiving surgical thromboprophylaxis for 14 or 28 days, which then makes it difficult to compare rates between studies [13,[15][16][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. All included studies, with the exception of two [19][20], did not clearly discuss or state the thromboprophylaxis measures employed.…”

“…The majority of papers included patients who had undergone cystectomy (n=33) (Figure 3). The further risk of VTE in patients receiving neoadjuvant or adjuvant chemotherapy (with curative intent) was only mentioned in four of the 33 papers [13][14][15][16]. There are no data on VTE in patients having multimodality treatments.…”

Venous Thromboembolism Rate in Patients With Bladder Cancer According to the Type of Treatment: A Systematic Review

“…There are many possible explanations for the large variations in the rates of VTE observed within this group: for example, the heterogeneity of risk factors in this population that could affect the rate of VTE such as minimal invasive (robotic) cystectomy or open radical cystectomy [10]. Additionally, 33 of the included studies did not state, discuss or categorise BC patients according to confounding factors that alter the rate of VTE such as receiving surgical thromboprophylaxis for 14 or 28 days, which then makes it difficult to compare rates between studies [13,[15][16][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. All included studies, with the exception of two [19][20], did not clearly discuss or state the thromboprophylaxis measures employed.…”

“…In our current review, the data from three studies that followed up the patients for three months after cystectomy revealed that VTE rates were still high; this may be due to patients having further treatment and hospitalisation [ 15 , 18 , 50 ]. According to the study by Wallis et al (2017), the VTE rate peaks at 20 days after cystectomy in BC patients; however, patients continue to be at risk of VTE long after surgery [ 16 ]. As found in this review, BC patients who had undergone cystectomy have an elevated risk of VTE for up to three months after surgery [ 13 ].…”