Perioperative mortality for radical cystectomy in the modern Era: experience from a tertiary referral center

ABSTRACT Purpose To evaluate the perioperative mortality and contributing variables among patients who underwent radical cystectomy (RC) for bladder cancer in recent decades, with comparison between modern (after 2010) and premodern (before 2010) eras. Materials and Methods Using our institutional review board-approved database, we reviewed the records of patients who underwent RC for primary urothelial bladder carcinoma with curative intent from January 2003 to December 2019. The primary and secondary outcomes were 90- and 30-day mortality. Univariate and multivariable logistic regression models were applied to assess the impact of perioperative variables on 90-day mortality. Results A total of 2047 patients with a mean±SD age of 69.6±10.6 years were included. The 30- and 90-day mortality rates were 1.3% and 4.9%, respectively, and consistent during the past two decades. Among 100 deaths within 90 days, 18 occurred during index hospitalization. Infectious, pulmonary, and cardiac complications were the leading mortality causes. Multivariable analysis showed that age (Odds Ratio: OR 1.05), Charlson comorbidity index ≥ 2 (OR 1.82), blood transfusion (OR 1.95), and pathological node disease (OR 2.85) were independently associated with 90-day mortality. Nevertheless, the surgical approach and enhanced recovery protocols had no significant effect on 90-day mortality. Conclusion The 90-day mortality for RC is approaching five percent, with infectious, pulmonary, and cardiac complications as the leading mortality causes. Older age, higher comorbidity, blood transfusion, and pathological lymph node involvement are independently associated with 90-day mortality.

Oncological outcomes of laparoscopic radical nephrectomy for renal cancer

PURPOSE: To report the 5-year oncological outcomes of patients undergoing laparoscopic radical nephrectomy for renal cancer compared to a cohort of patients undergoing open radical nephrectomy. METHODS: We retrospectively analyzed the data of 88 patients undergoing radical nephrectomy for renal cell carcinoma prior to January 2000. Of these, 45 patients underwent laparoscopic radical nephrectomy, and 43 patients underwent open radical nephrectomy. Inclusion criteria comprised clinically organ-confined tumors of 15 cm or less in size without concomitant lymphadenopathy or vena cava thrombus. Oncological follow-up data were obtained from charts, radiological reports, and phone calls to patients or their families, and were calculated from the date of surgery to the date of last appointment with physician or date of death. RESULTS: All laparoscopic procedures were completed without open conversion. On comparing the laparoscopic radical nephrectomy and open radical nephrectomy groups, mean tumor size was 5. 8 vs 6.2 cm (P = . 44), mean blood loss was 183 vs 461 mL (P = . 004), and mean operative time was 2.8 vs 3.7 hrs (P < . 001). Over a mean follow-up of 5 years in the laparoscopic radical nephrectomy group and 6 years in the open radical nephrectomy group, the overall survival was 81 percent vs 79 percent (P = . 47), and cancer-specific survival was 90 percent vs 92 percent (P = . 70) , respectively. CONCLUSIONS: Laparoscopic radical nephrectomy for renal cancer confers equivalent 5-year oncological outcomes to those of open surgery.

OBJETIVO: Relatar os resultados oncológicos após 5 anos de seguimento em pacientes submetidos a nefrectomia radical laparoscópica para tratamento do câncer renal, comparando esses com os resultados obtidos com um grupo de pacientes submetidos a nefrectomia radical aberta. MÉTODOS: Foram analisadas retrospectivamente as informações obtidas de 88 pacientes submetidos a nefrectomia radical para o tratamento do carcinoma renal realizadas previamente a Janeiro de 2000. Destes pacientes, 45 foram tratados com nefrectomia radical laparoscópica e 43 com nefrectomia radical aberta. Foram incluídos pacientes com tumores localizados com tamanho máximo de 15 cm, sem adenopatia ou sinal de envolvimento de veia renal na avaliação radiologica pré-operatória. As informações sobre o seguimento dos pacientes foram obtidas a partir de prontuários, laudos de exames radiológicos e ligações telefônicas para pacientes e/ou familiares. O seguimento foi calculado desde a data da cirurgia até a última consulta médica ou data de falecimento. RESULTADOS: Todos os procedimentos laparoscópicos foram realizados sem conversão para a técnica aberta. O tamanho médio tumoral foi de 5.8 e. 6.2 cm (P=0.44), perda sanguínea estimada de 183 e. 461 mL (P=0.004), e tempo operatório de 2.8 e. 3.7 horas (P<0.001) , respectivamente para os grupos nefrectomia radical laparoscópica e nefrectomia radical aberta. O tempo de seguimento médio foi de 5 anos para o grupo nefrectomia radical laparoscópica e 6 anos para o grupo nefrectomia radical aberta. A sobrevida global após 5 anos foi de 81 por cento e 79 por cento (P=0.47), e a sobrevida específica para cancer foi de 90 por cento e 92 por cento (P=0.70), para os grupos nefrectomia radical laparoscópica e nefrectomia radical aberta respectivamente. CONCLUSÃO: A nefrectomia radical laparoscópica tem resultados oncológicos em 5 anos similares a técnica convencional aberta.

Pattern of metastases in renal cell carcinoma: a single institution study.

BACKGROUND: Increasing numbers of patients with renal cell carcinoma (RCC) are incidentally detected and can be potentially cured by surgery alone. In treating metastatic RCC, worthwhile survival rates are achieved in cases of low burden recurrences. This necessitates a rational follow up protocol, which picks up early recurrences and avoids costly surveillance for those with a favorable prognosis. AIMS: We studied the patterns of metastases occurring in patients operated for localized or locally advanced renal cell carcinoma in the Indian setting and try to evolve a suitable follow up protocol. SETTING AND DESIGN: Institution based, retrospective data. METHOD AND MATERIALS: Records of patients from January 1988 to December 2003, operated for initially localized RCC were reviewed. Follow up was performed using an established protocol. Occurrence of metastases and their patterns were studied. STATISTICAL ANALYSIS USED: Comparison of the different survival times was performed using the one-way analysis method. Multiple comparisons (post hoc test) were performed using the Bonferroni method. RESULT: Follow up was available on 209 patients. Mean survival was 43.75 months (SD +/- 28.72). Thirty-nine patients developed 59 metastases. Lungs were the commonest site of metastases (37%), followed by bone (22%), liver (19%) and brain (8%). Relapse and survival showed significant correlation with pathological stage (p CONCLUSIONS: Occurrence of metastases correlate with the pathological stage of the disease at primary presentation. Tailored, stage-based follow up protocols allow adequate surveillance for disease activity and progression without escalating the overall costs.