ABSTRACT
INTRODUCTION: We investigated barriers to the receipt of neoadjuvant chemotherapy by patients undergoing radical cystectomy. METHODS: After institutional review board approval we performed a retrospective chart review from January 1, 2012 to March 1, 2018 of cases of radical cystectomy with urinary diversion for bladder cancer. Patients were placed in 1 of 3 groups according to eligibility to receive neoadjuvant chemotherapy before undergoing cystectomy, as "NAC" if they received neoadjuvant chemotherapy, "No NAC - Declined" if they were eligible but declined neoadjuvant chemotherapy and "No NAC - Ineligible" if they were clinically ineligible to receive neoadjuvant chemotherapy. We performed univariate and multivariate analyses on social and pathological factors in these 3 categories. RESULTS: Of 268 patients identified 209 were eligible to be included in this study. On univariate analysis statistical differences were noted according to age and distance from treatment center. On pathological analysis stage was statistically different between the cohorts. A multivariate analysis revealed that single patients were more likely to decline neoadjuvant chemotherapy as opposed to married patients. CONCLUSIONS: Neoadjuvant chemotherapy before radical cystectomy for muscle invasive bladder cancer continues to be an underused treatment modality in South Florida. Age, marital status and distance from treatment center all appear to have an impact on patient acceptance of or referring doctor recommendations for neoadjuvant chemotherapy. We suggest larger multi-institutional studies to further assess this issue.
ABSTRACT
Surgical site infection rates remain a common postoperative problem that continues to affect patients undergoing urologic surgery. Our study seeks to evaluate the difference in surgical site infection rates in patients undergoing open radical cystectomy when comparing the Bookwalter vs. the Alexis wound retractors. After institutional review board approval, we performed a retrospective chart review from February 2010 through August 2017 of patients undergoing open radical cystectomy with urinary diversion for bladder cancer. We then stratified the groups according to whether or not the surgery was performed with the Alexis or standard Bookwalter retractor. Baseline characteristics and operative outcomes were then compared between the two groups, with the main measure being incidence of surgical site infection as defined by the CDC. We evaluated those presenting with surgical site infections within or greater than 30 postoperatively. Of 237 patients who underwent radical cystectomy with either the Alexis or Bookwalter retractor, 168 patients were eligible to be included in our analysis. There was no statistical difference noted regarding surgical site infections (SSIs) between the two groups; however, the trend was in favor of the Alexis (3%) vs. the Bookwalter (11%) at less than 30 days surgery. The Alexis wound retractor likely poses an advantage in reducing the incidence in surgical site infections in patients undergoing radical cystectomy; however, multicenter studies with larger sample sizes are suggested for further elucidation.
