Aim of the study The Radical Cystectomy (RC) is the standard management of muscle invasive bladder cancer(MIBC). The simplest urinary diversion after radical cystectomy is bilateral ureterocutaneostomy (UCS), a surgical procedure suitable especially for patients with poor performance status or advanced disease. Overall, complications are common after RC. In particular, gastrointestinal complications (GIC) are one of the most reported complications, ranging in incidence between 0.7% and 11%. The aim of this work is to evaluate main complications rates after UCS vs. other diversion (no-UCS) RC with a specific focus on GIC. Materials and methods Data of patients underwent Radical Cystectomy (Current Procedural Terminology [CPT] codes: 51590, 51595, and 51596) for bladder cancer (International Classification of Diseases 9th edition [ICD-9] codes: 188.x) were sourced from a retrospective cystectomy database collected in 20 different European centers (index period 2010-2017). Data included patient demographics, preoperative comorbidities, and laboratory exams results, intraoperative reports, as well as postoperative morbidity and mortality for the subsequent 6 months period. Postoperative complications were classified according to the Clavien-Dindo score. We stratified the cohort in two groups: patients with ureterocutaneostomy (UCS) vs. patients with other urinary diversion (no-UCS) Results Our database included 688 patients underwent RC for bladder cancer. A total of 330 patients (47.9%) received the UCS as urinary diversion, while 358 received a no-UCS one. Median age at surgery was 68.0 (IQR: 61.0-74.0) years for UCS patients and 76.0 (IQR: 69.0-80.0) years for no-UCS patients (p<0.001). Despite younger, UCS patients were more frequently classified as ASA score 4 compared to no-UCS patients (9.1 vs. 3.7%, p<0.001). Patients who underwent UCS were more frequently male compared to no-UCS patients (46.1 vs. 39.7%, p=0.038). Moreover, UCS patients harbored more frequently larger primary tumors (24.0 mm vs. 19.4 m, p<0.001). Overall, lower complications rates were recorded in the UCS group compared to the no-UCS group (12.7 vs. 17.6%, p=0.007). Furthermore, lower Cliavien-Dindo grade III-V were recorded in the UCS patients compared to no-UCS patients (7.2 vs. 12.9%, p=0.001). GIC were less frequently observed in the UCS group compared to the no-UCS group (12.8 vs 18.4%, p=0.001). The most common GIC was a mild postoperative ileus (POI) with a late intestinal recanalization, in 11 cases (19.0%). Discussion RC with UCS is a standardized procedure for treatment of aggressive BC. RC with UCS is burdened by lower rates of higher grade complications compared to no-UCS procedures, as result of the fact that bowel is not directly involved in the surgical technique. The higher safety profile allowed the use of this surgical technique even in those with higher comorbidities as higher ASA score.
SC212 RADICAL CISTECTOMY WITH URETEROCUTANEOSTOMY: CONTEMPORARY RAPPRAISAL OF A CLASIQUE TECHNIQUE FOR THE MANAGEMENT OF MUSCLE INVASIVE BLADDER CANCER
Castellani D;
2019-01-01
Abstract
Aim of the study The Radical Cystectomy (RC) is the standard management of muscle invasive bladder cancer(MIBC). The simplest urinary diversion after radical cystectomy is bilateral ureterocutaneostomy (UCS), a surgical procedure suitable especially for patients with poor performance status or advanced disease. Overall, complications are common after RC. In particular, gastrointestinal complications (GIC) are one of the most reported complications, ranging in incidence between 0.7% and 11%. The aim of this work is to evaluate main complications rates after UCS vs. other diversion (no-UCS) RC with a specific focus on GIC. Materials and methods Data of patients underwent Radical Cystectomy (Current Procedural Terminology [CPT] codes: 51590, 51595, and 51596) for bladder cancer (International Classification of Diseases 9th edition [ICD-9] codes: 188.x) were sourced from a retrospective cystectomy database collected in 20 different European centers (index period 2010-2017). Data included patient demographics, preoperative comorbidities, and laboratory exams results, intraoperative reports, as well as postoperative morbidity and mortality for the subsequent 6 months period. Postoperative complications were classified according to the Clavien-Dindo score. We stratified the cohort in two groups: patients with ureterocutaneostomy (UCS) vs. patients with other urinary diversion (no-UCS) Results Our database included 688 patients underwent RC for bladder cancer. A total of 330 patients (47.9%) received the UCS as urinary diversion, while 358 received a no-UCS one. Median age at surgery was 68.0 (IQR: 61.0-74.0) years for UCS patients and 76.0 (IQR: 69.0-80.0) years for no-UCS patients (p<0.001). Despite younger, UCS patients were more frequently classified as ASA score 4 compared to no-UCS patients (9.1 vs. 3.7%, p<0.001). Patients who underwent UCS were more frequently male compared to no-UCS patients (46.1 vs. 39.7%, p=0.038). Moreover, UCS patients harbored more frequently larger primary tumors (24.0 mm vs. 19.4 m, p<0.001). Overall, lower complications rates were recorded in the UCS group compared to the no-UCS group (12.7 vs. 17.6%, p=0.007). Furthermore, lower Cliavien-Dindo grade III-V were recorded in the UCS patients compared to no-UCS patients (7.2 vs. 12.9%, p=0.001). GIC were less frequently observed in the UCS group compared to the no-UCS group (12.8 vs 18.4%, p=0.001). The most common GIC was a mild postoperative ileus (POI) with a late intestinal recanalization, in 11 cases (19.0%). Discussion RC with UCS is a standardized procedure for treatment of aggressive BC. RC with UCS is burdened by lower rates of higher grade complications compared to no-UCS procedures, as result of the fact that bowel is not directly involved in the surgical technique. The higher safety profile allowed the use of this surgical technique even in those with higher comorbidities as higher ASA score.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
