UP-01.057 Sub Staging of T1 Bladder Cancer: Relationship of Progression and Recurrence to Depth of Invasion (original) (raw)
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Enhanced Recovery after Surgery in Patients Undergoing Radical Cystectomy for Bladder Cancer
The Journal of Urology, 2014
Purpose: Enhanced recovery after surgery protocols aim to improve patient care and decrease complications and hospital stay. We evaluated our enhanced recovery after surgery protocol, focusing on length of stay, early complication and readmission rates after radical cystectomy for bladder cancer. Materials and Methods: From May 2012 to July 2013 a perioperative protocol was applied in 126 consecutive patients who underwent open radical cystectomy and urinary diversion. Nonconsenting patients (2), those with previous diversion (2) and prolonged postoperative intubation (3), and those who underwent additional surgery (9) were excluded from study. The protocol focuses on avoiding bowel preparation and nasogastric tube, early feeding, nonnarcotic pain management and the use of cholinergic and m-opioid antagonists. Outcomes were compared to those in matched controls from our bladder cancer database. Results: A total of 110 patients with a median age of 69 years were included in analysis, of whom 68% underwent continent urinary diversion. Of the patients 82% had a bowel movement by postoperative day 2. Median length of stay was 4 days. The 30-day minor and major complication rates were 64% and 14%, respectively. The most common minor complication was anemia requiring transfusion in 19% of patients, urinary tract infection in 13% and dehydration in 10%. The latter 2 complications were the most common etiologies for readmission. The 30-day readmission rate was 21% (23 patients). Patients 75 years old or older had a longer length of stay (5 vs 4 days, p ¼ 0.03) and a higher minor complication rate (72% vs 51%, p ¼ 0.04) than younger patients. Conclusions: Our enhanced recovery after surgery protocol expedites bowel function recovery and shortens hospital stay after RC and urinary diversion without an increase in the hospital readmission rates. Abbreviations and Acronyms ERAS ¼ enhanced recovery after surgery LOS ¼ length of hospital stay POD ¼ postoperative day POI ¼ postoperative ileus RC ¼ radical cystectomy TPN ¼ total parenteral nutrition
Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer
Canadian Urological Association Journal, 2018
Introduction: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care protocols that are designed to shorten recovery time and reduce complication rates.1,2 An ERAS protocol was implemented in the Saskatoon Health region for radical cystectomy patients in 2013. This study evaluates the safety and efficacy of the protocol for patients having radical cystectomy for bladder cancer. Methods: Length of stay (LOS), early in-hospital complication rates, 30-day readmission rates, age, and gender were collected for patients seen for bladder cancer requiring radical cystectomy in Saskatoon between January 2007 and December 2016. Of these patients, 176 were pre-ERAS implementation (control group) and 84 were post-ERAS implementation (experimental group). The data from each variable was compared between the groups using a Z-test. Results: There was no significant difference in age or gender of patients between the groups. Average LOS pre-ERAS was 14.25±14.57 days, whi...
Prognostic Factors Toward Bladder Cancer Patient Recovery After Radical Cystectomy Surgery
Indonesian Journal of Urology, 2021
Objective: This study aimed to know independent prognostic factors to predict the recovery time of bladder cancer patients after radical cystectomy. So that it would be a consideration to determine patient feasibility before surgery and after surgery management. Material & Methods: This study was an observational analytical study with a retrospective approach to examine the relationship between pre-surgery variables of the bladder cancer patients and the duration of treatment post radical cystectomy. Results: From the results of this study, it is known that the average length of postoperative care for older patients (above 65 years) was lower when compared to patients under 65 years with averages of 17.08 and 18.03 days respectively p-value of this analysis was 0.781. Patients with low hemoglobin, albumin, and HALP scores had longer postoperative hospitalization periods but with P values of 0.384, 0.276, and 0.603, the ileal conduit has the longest hospitalization treatment period b...
Therapeutic Advances in Urology
Background: Enhanced recovery after surgery (ERAS) protocols decrease the length of hospital stay (LOS) and complications following radical cystectomy (RC). However, the impact of non-modifiable patient factors to postoperative outcome is unclear. This study aimed to identify nonmodifiable patient and disease factors predictive of post-RC outcomes with ERAS protocols. Methods: We reviewed our institutional review board-approved prospectively maintained bladder cancer database. Patients with primary urothelial bladder cancer who underwent open RC with ERAS protocol between 2012 and 2016 were identified. Patient demographic and disease-relevant variables were reviewed. Factors predictive of LOS, 30- and 90-day complications and readmission were assessed using univariate and multivariable analyses. Results: A total of 289 patients with a median age of 70 years were included, of whom 80.6% were male, 33.6% had Charlson comorbidity index ⩾2. Median LOS was 4 days and 21.1% received intra...
Enhanced recovery pathway following radical cystectomy
Current Opinion in Urology, 2014
Purpose: Enhanced recovery after surgery protocols aim to improve patient care and decrease complications and hospital stay. We evaluated our enhanced recovery after surgery protocol, focusing on length of stay, early complication and readmission rates after radical cystectomy for bladder cancer. Materials and Methods: From May 2012 to July 2013 a perioperative protocol was applied in 126 consecutive patients who underwent open radical cystectomy and urinary diversion. Nonconsenting patients (2), those with previous diversion (2) and prolonged postoperative intubation (3), and those who underwent additional surgery (9) were excluded from study. The protocol focuses on avoiding bowel preparation and nasogastric tube, early feeding, nonnarcotic pain management and the use of cholinergic and m-opioid antagonists. Outcomes were compared to those in matched controls from our bladder cancer database. Results: A total of 110 patients with a median age of 69 years were included in analysis, of whom 68% underwent continent urinary diversion. Of the patients 82% had a bowel movement by postoperative day 2. Median length of stay was 4 days. The 30-day minor and major complication rates were 64% and 14%, respectively. The most common minor complication was anemia requiring transfusion in 19% of patients, urinary tract infection in 13% and dehydration in 10%. The latter 2 complications were the most common etiologies for readmission. The 30-day readmission rate was 21% (23 patients). Patients 75 years old or older had a longer length of stay (5 vs 4 days, p ¼ 0.03) and a higher minor complication rate (72% vs 51%, p ¼ 0.04) than younger patients. Conclusions: Our enhanced recovery after surgery protocol expedites bowel function recovery and shortens hospital stay after RC and urinary diversion without an increase in the hospital readmission rates. Abbreviations and Acronyms ERAS ¼ enhanced recovery after surgery LOS ¼ length of hospital stay POD ¼ postoperative day POI ¼ postoperative ileus RC ¼ radical cystectomy TPN ¼ total parenteral nutrition
Journal of thee Medical Sciences (Berkala Ilmu Kedokteran), 2020
Radical cystectomy (RC) remains associated with a greater number of postsurgical complications than any urological procedure. Enhanced recovery after surgery (ERAS) protocol is a multimodal perioperative care pathway designed to achieve early postsurgical recovery. We evaluated the perioperative outcome of post-RC patients, comparing the effectiveness of ERAS to conventional recovery protocols. We identified 37 patients who underwent RC for bladder cancer from 2016 to 2018. The characteristics, complication rate and clinical outcomes were evaluated in these groups of patients. In this study, the mortality was 8.1%, and the complications were 37.8%. The most frequent complications were anastomotic leakage (16.2%), wound dehiscence (13.5%), infections/sepsis (8.1%), and paralytic ileus (8.1%). The ERAS protocol significantly reduced operative time (p=0.001; OR=216; CI95%: 12.0-3855.2) and reduced overall complications (p=0.04; OR= 0.14 CI95%: 0.016-1.132). Extensive complications and mortality develop following the RC procedure. Meanwhile, refinement in perioperative care has been reducing the rate of serious complications. The ERAS protocol distinctly reduces the post-RC complication rate.
African Journal of Urology
Background: Although pathological factors remain the main determinate of survival for patients with bladder cancer, quality of surgical care is crucial for satisfactory outcomes. Using a validated quality score, we investigated the impact of surgical factors on the overall survival (OS), recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with locally advanced and organ-confined disease (OCD). Retrospective review of IRCC database includes 2460 patients from 29 institutions across 11 countries. The final cohort included 1343 patients who underwent RARCs between 2005 and 2016. Patients with locally advanced disease (LAD) (> pT2 and/or N +) were compared with OCD (≤ pT2/N0). Validated Quality Cystectomy Score (QCS) based on four sets of quality metrics was used to compare surgical performance. Kaplan-Meier method was used to compute RFS, CSS and OS rates. Multivariable stepwise logistic regression was used to evaluate variables associated with RFS, DSS and OS. Results: 48% had LAD. When compared to patients with OCD, they received neobladders less frequently (17% vs. 28%, p < 0.001) and experienced higher estimated blood loss (513 vs. 376 ml, p = 0.05). Postoperatively, more patients in the LAD group received adjuvant chemotherapy (24% vs. 4%, p < 0.001) and positive surgical margins (14% vs. 2%, p < 0.001) and had higher 90-day mortality (6% vs. 2%, p < 0.001). On multivariable analysis, female gender, higher QCS score, intracorporeal diversion, pT stage, positive lymph node status and recurrence are considered as predictors of survival. Patients with OCD exhibited better RFS, DSS and OS than patients with LAD. For patients with OCD, higher QCS was associated with improved OS but not RFS or DSS. On the other hand, patients with LAD and higher QCS exhibited higher RFS, DSS and OS when compared to those with lower QCS.
Introduction of an enhanced recovery protocol for radical cystectomy
BJU International, 2008
To describe and assess an enhanced recovery protocol (ERP) for the peri-operative management of patients undergoing radical cystectomy (RC), which was started at our institution on 1 October 2005, as RC is associated with increased morbidity and longer inpatient stays than other major urological procedures. An ERP was introduced in our institution that focused on reduced bowel preparation, and standardized feeding and analgesic regimens. In all, 112 consecutive patients were compared, i.e. 56 before implementing the ERP and 56 since introducing the ERP. The primary outcome measures were duration of total inpatient stay and interval from surgery to discharge, and the morbidity and mortality. Data were analysed retrospectively from cancer network and hospital records. The demographics of the two groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade, or type of urinary diversion. Re-admission, mortality and morbidity rates showed no statistically significant difference between the groups. The median (interquartile range) duration of hospital stay was 17 (15-23) days in the no-ERP group, and 13 (11-17) days in the ERP group (significantly different, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, Wilcoxon rank-sum test). The median duration of recovery after RC was 15 (13-21) days in the no-ERP group and 12 (10-15) days in the ERP group (significantly different, P = 0.001, Wilcoxon rank-sum test). The introduction of an ERP was associated with significantly reduced hospital stay, with no deleterious effect on morbidity or mortality.
Prospective Implementation of Enhanced Recovery After Surgery Protocols to Radical Cystectomy
European Urology, 2017
Background: Multimodal enhanced recovery after surgery (ERAS) regimens have improved outcomes from colorectal surgery. Objective: We report the application of ERAS to patients undergoing radical cystectomy (RC). Design, Setting and Participants: Prospective collection of outcomes from consecutive patients undergoing RC at a single institution. Intervention: Twenty-six components including prehabilitation exercise, same day admission, carbohydrate fluid loading, targeted intra-operative fluid resuscitation, regional local anesthesia, cessation of NG tubes, omitting oral bowel preparation, avoiding drain use, early mobilization, chewing gum use and audit. Outcome Measurements and Statistical Analysis: Primary outcomes were length of stay and readmission rate. Secondary outcomes included intra-operative blood loss, transfusion rates, survival and histopathological findings. Results and Limitations: 453 consecutive patients underwent RC, including 393 (87%) with ERAS. Length of stay was shorter with ERAS (median (IQR): 8 (6-13) days) than without (18 (13-25), p<0.001). Patients with ERAS had lower blood loss (ERAS: 600 (383-969) mls vs. 1050 (900-1575) mls for non-ERAS, p<0.001), lower transfusion rates (ERAS: 8.1% vs. 25%, Chi sq. p<0.001) and fewer readmissions (ERAS: 15% vs. 25%, Chi sq. p=0.04) than those without. Histopathological parameters (e.g. tumor stage, node count and margin state) and survival outcomes did not differ with ERAS use (all p>0.1). Multivariable analysis revealed ERAS use was (p=0.002) independently associated with length of stay. 3 Conclusions: The use of ERAS pathways was associated with lower intra-operative blood loss and faster discharge for patients undergoing RC. These changes did not increase readmission rates or alter oncological outcomes. Patient summary: Recovery after major bladder surgery can be improved by using enhanced recovery pathways. Patients managed by these pathways have shorter length of stays, lower blood loss and lower transfusion rates. Their adoption should be encouraged.