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Perioperative and Long-term Oncological Outcomes of Patients with Muscle Invasive Bladder Cancer Who Underwent Radical Cystectomy—a Single-Center Experience

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Abstract

The current study aimed to report on the perioperative and long-term oncological outcomes of patients with muscle invasive bladder cancer who underwent radical cystectomy. Between January 2012 and December 2018, 207 patients were diagnosed with muscle invasive bladder cancer at our center, among whom 61 underwent radical cystectomy with a mean follow-up duration of 45.7 months. Postoperative complications were graded based on the Clavien–Dindo classification within 90 days after radical cystectomy. Disease-free survival and overall survival rates were determined according to tumor stage. Risk factors for perioperative complications, recurrence, and survival were assessed. The patients (n = 61) had a mean hospital stay of 20.9 days, with urinary diversion (23%), infection (18%), and blood transfusion (11.4%) being the most common complications following radical cystectomy. All complications were classified below Clavien–Dindo classification grade 3, most of which were controlled by conservative treatment. Re-operation within 90 days was required in 7 patients (11.5%) for enterolysis or cystorrhaphy, with no reported mortality after radical cystectomy. Carefully selected patients who underwent radical cystectomy, especially those with a Charlson Comorbidity Index of 0, 1, and 2 and clinical stage of T2 and T3, demonstrated better oncological outcomes compared to those who underwent trimodal therapy. The current study showed that adequately selected patients who underwent radical cystectomy had better oncological outcome compared to those who underwent trimodal therapy. The risk factors for perioperative complications included diabetes mellitus, male sex, smoking habit, alcohol consumption, and betel nut consumption.

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References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7–33. https://doi.org/10.3322/caac.21654

    Article  PubMed  Google Scholar 

  2. Flaig TW, Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK et al (2020) Bladder cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 18:329–354. https://doi.org/10.6004/jnccn.2020.0011

    Article  PubMed  Google Scholar 

  3. Giacalone NJ, Shipley WU, Clayman RH, Niemierko A, Drumm M, Heney NM et al (2017) Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer: an updated analysis of the Massachusetts General Hospital experience. Eur Urol 71:952–960. https://doi.org/10.1016/j.eururo.2016.12.020

    Article  PubMed  Google Scholar 

  4. Seisen T, Sun M, Lipsitz SR, Abdollah F, Leow JJ, Menon M et al (2017) Comparative effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder. Eur Urol 72:483–487. https://doi.org/10.1016/j.eururo.2017.03.038

    Article  PubMed  Google Scholar 

  5. Paramasivan S, Huddart R, Hall E, Lewis R, Birtle A, Donovan JL (2011) Key issues in recruitment to randomised controlled trials with very different interventions: a qualitative investigation of recruitment to the SPARE trial (CRUK/07/011). Trials 12:78. https://doi.org/10.1186/1745-6215-12-78

    Article  PubMed  PubMed Central  Google Scholar 

  6. Smith AB, Deal AM, Woods ME, Wallen EM, Pruthi RS, Chen RC et al (2014) Muscle-invasive bladder cancer: evaluating treatment and survival in the National Cancer Data Base. BJU Int 114:719–726. https://doi.org/10.1111/bju.12601

    Article  PubMed  Google Scholar 

  7. Bekelman JE, Handorf EA, Guzzo T, Pollack CE, Christodouleas J, Resnick MJ et al (2013) Radical cystectomy versus bladder-preserving therapy for muscle-invasive urothelial carcinoma: examining confounding and misclassification bias in cancer observational comparative effectiveness research. Value Health 16:610–618. https://doi.org/10.1016/j.jval.2013.01.005

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gofrit ON, Nof R, Meirovitz A, Pode D, Frank S, Katz R et al (2015) Radical cystectomy vs. chemoradiation in T2–4aN0M0 bladder cancer: a case-control study. Urol Oncol 33:19.e1-19.e5. https://doi.org/10.1016/j.urolonc.2014.09.014

    Article  PubMed  Google Scholar 

  9. Witjes JA, Bruins HM, Cathomas R, Compérat EM, Cowan NC, Gakis G et al (2021) European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur Urol 79:82–104. https://doi.org/10.1016/j.eururo.2020.03.055

    Article  CAS  PubMed  Google Scholar 

  10. Krajewski W, Zdrojowy R, Tupikowski K, Małkiewicz B, Kołodziej A (2016) How to lower postoperative complications after radical cystectomy - a review. Cent European J Urol 69:370–376. https://doi.org/10.5173/ceju.2016.880

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A et al (2010) Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol 57:983–1001. https://doi.org/10.1016/j.eururo.2010.02.024

    Article  PubMed  Google Scholar 

  13. Partin AW (2020) Campbell-Walsh-Wein Urology. Elsevier, 12th edition.

  14. Taneja S (2017) Complications of urologic surgery. Elsevier, 5th edition.

  15. Teoh JYC, Yee CH, Chiu PKF, Chan VWS, Chan EOT, Ng CF et al (2021) Key steps in performing robotic-assisted radical cystectomy with intracorporeal urinary diversion and the evidence that we have so far. Uro Sci 32:46–51. https://doi.org/10.4103/UROS.UROS_108_20

    Article  Google Scholar 

  16. Roghmann F, Trinh QD, Braun K, Bodman CV, Brock M, Noldus J et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21:143–149. https://doi.org/10.1111/iju.12232

    Article  PubMed  Google Scholar 

  17. Lin JH, Chiu KH, Ho DR, Huang YC, Huang KT, Chen CS et al (2018) Performing laparoscopic radical cystectomy is feasible for the elderly with marginal cardiopulmonary function. Uro Sci 29:20–24. https://doi.org/10.4103/UROS.UROS_9_17

    Article  Google Scholar 

  18. Henningsohn L, Steven K, Kallestrup EB, Steineck G (2002) Distressful symptoms and well-being after radical cystectomy and orthotopic bladder substitution compared with a matched control population. J Urol 168:168–174. https://doi.org/10.1016/s0022-5347(05)64854-9

    Article  PubMed  Google Scholar 

  19. Pramod SV, Safriadi F, Hernowo BS, Dwiyana RF, Partogu B (2020) Modified enhanced recovery after surgery protocol versus nonenhanced recovery after surgery in radical cystectomy surgery (preliminary study). Uro Sci 31:177–182. https://doi.org/10.4103/UROS.UROS_8_20

    Article  Google Scholar 

  20. Johnson SC, Smith ZL, Golan S, Rodriguez JF, Pearce SM, Smith ND et al (2018) Perioperative and long-term outcomes after radical cystectomy in hemodialysis patients. Urol Oncol 36:237.e19-e24. https://doi.org/10.1016/j.urolonc.2017.12.024

    Article  PubMed  Google Scholar 

  21. Oh JJ, Kang MY, Jo JK, Lee HM, Byun SS, Lee SE et al (2015) Association between diabetes mellitus and oncological outcomes in bladder cancer patients undergoing radical cystectomy. Int J Urol 22:1112–1117. https://doi.org/10.1111/iju.12901

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to acknowledge Drs. Tseng, Chien-Chang, Ying-Hsia, and Shen for their guidance.

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Correspondence to Wen-Hsin Tseng.

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Chen, ZH., Tseng, WH., Huang, S.K. et al. Perioperative and Long-term Oncological Outcomes of Patients with Muscle Invasive Bladder Cancer Who Underwent Radical Cystectomy—a Single-Center Experience. Indian J Surg 85, 280–287 (2023). https://doi.org/10.1007/s12262-022-03404-5

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