Impairment in Activities of Daily Living Assessed by the Barthel Index Predicts Adverse Oncological Outcomes After Radical Cystectomy for Bladder Cancer.

INTRODUCTION: We tested the association between functional impairment in activities of daily living (ADL) assessed through the Barthel Index (BI), and oncological outcomes following radical cystectomy (RC) for bladder cancer (BCa). PATIENTS AND METHODS: We retrospectively analyzed data of 262 clinically nonmetastatic BCa patients, who underwent RC between 2015 and 2022, with available follow-up. According to preoperative BI, patients were divided in 2 groups: BI ≤90 (moderate/severe/total dependency in ADL) versus BI 95 to 100 (slight dependency/independency in ADL). Kaplan-Meier plots compared disease recurrence (DR)-, cancer-specific mortality (CSM)-, and overall mortality (OM)-free survival according to established categories. Multivariable Cox regression models tested the BI as an independent predictor of oncological outcomes. RESULTS: According to the BI, the patient cohort was distributed as follows: 19% (n = 50) BI ≤90 versus 81% (n = 212) BI 95-100. Compared to patients with BI 95 to 100, patients with BI ≤90 were less likely to receive intravesical immuno- or chemotherapy (18% vs. 34%, p = .028), and more frequently underwent less complex urinary diversion as ureterocutaneostomy (36% vs. 9%, p < .001), or harbored muscle-invasive BCa at final pathology (72% vs. 56%, p = .043). In multivariable Cox regression models adjusted for age, ASA physical status score, pathological T and N stage, and surgical margins status, BI ≤90 independently predicted higher DR (HR [hazard ratio]:2.00, 95%CI [confidence interval]:1.21-3.30, p = .007), CSM (HR:2.70, 95%CI:1.48-4.90, p = .001), and OM (HR:2.09, 95%CI:1.28-3.43, p = .003). CONCLUSION: Preoperative impairment in ADL was associated with adverse oncological outcomes following RC for BCa. The integration of the BI into clinical practice may improve the risk assessment of BCa patients candidates to RC.

Laparoscopic adrenalectomy for large adrenal tumor guided by a 3D anatomic model. New frontiers in abdominal surgery.

If until few years ago the surgeon could study a complex surgery only on the basis of two-dimensional images, today can use 3D physical models on a scale of 1 to 1 of an organ. We report the case of a 53 years old woman with Cushing's syndrome and a giant right adrenal tumor. To better define the relationship between the neoplasm and inferior vena cava, the vascularization of the adrenal gland, any anatomical anomalies and the specific location of the middle adrenal vein, a 3D printed model was created in 1: 1 size based on the preoperative CT. A laparoscopic right adrenalectomy was performed. No intraoperative and postoperative complications were observed with resolution of the adrenal disorder. This case highlights the feasibility and clinical effectiveness of 3D anatomical models for correct preoperative planning, the surgeon's intraoperative guidance to reduce possible errors and therefore improve the patient's postoperative outcome.