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1.
Adv Clin Exp Med ; 30(1): 77-82, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33529510

RESUMO

BACKGROUND: Bladder cancer is one of the most common cancers in Europe and is mostly found in men. Cystectomy is the treatment for invasive tumors that infiltrate the muscle of the bladder. This procedure is associated with a large number of complications. Eligibility for surgical treatment is important, because surgery may shorten the patient's life. The main prognostic factor is the severity of the disease, but less specific factors can be very helpful in selecting the form of treatment. OBJECTIVES: To identify and analyze factors affecting significantly the survival in patients undergoing radical cystectomy (RC). MATERIAL AND METHODS: A retrospective analysis of a group of 129 patients treated at the Department of Urology and Urological Oncology of University Hospital in Wroclaw (Poland) was carried out. Furthermore, information about the results of laboratory tests from the medical records (blood count, creatinine concentration, etc.) was obtained. The follow-up was performed twice during the postoperative period. The Kaplan-Meier method was used to determine overall survival (OS) curves and statistical significance was assessed using log-rank test. RESULTS: A statistically significant correlation between preoperative serum creatinine level and OS was found. The OS was significantly shorter in patients with higher serum creatinine levels (log-rank test; p = 0.002). The patients were divided into different groups to exclude the relationship between the elevated creatinine concentration and the local disease advancement. The analysis was performed in patients with and without hydronephrosis. In both groups, creatinine levels above the acceptable range were associated with a shorter survival. CONCLUSIONS: Due to the high perioperative mortality, mainly in patients with advanced disease, it is necessary to develop the qualification process for surgical treatment. The awareness of the relationship between elevated creatinine levels and worse prognosis seems to be helpful.


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária , Creatinina , Cistectomia/efeitos adversos , Humanos , Polônia , Prognóstico , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia
2.
J Urol ; 205(1): 94-99, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32716672

RESUMO

PURPOSE: Treatment for muscle invasive bladder cancer includes radical cystectomy, a major surgery that can be associated with significant toxicity. Limited data exist related to changes in patient global health status and recovery following radical cystectomy. We used geriatric assessment to longitudinally compare health related impairments in older and younger patients with muscle invasive bladder cancer who undergo radical cystectomy. MATERIALS AND METHODS: Older and younger patients (70 or older and younger than 70 years) with muscle invasive bladder cancer undergoing radical cystectomy at an academic institution were enrolled between 2012 and 2019. Patients completed the geriatric assessment before radical cystectomy, and 1, 3 and 12 months after radical cystectomy. For each geriatric assessment measure the Wilcoxon rank sum test was used to compare score distribution between age groups at each time point. The Wilcoxon signed rank test was used to compare distributions between time points within each age group. RESULTS: A total of 80 patients (42 younger and 38 older) were enrolled. Before radical cystectomy 78% of patients were impaired on at least 1 geriatric assessment measure. Both age groups had worsening physical function and nutrition at 1 month after radical cystectomy, with older patients having a greater decline in function than younger patients. Both groups recovered to baseline at 3 months after radical cystectomy and maintained this status at 1 year. CONCLUSIONS: High rates of impairments were found across age groups in the short term after radical cystectomy, followed by recovery to baseline.


Assuntos
Cistectomia/efeitos adversos , Fragilidade/diagnóstico , Avaliação Geriátrica/estatística & dados numéricos , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Recuperação Pós-Cirúrgica Melhorada , Feminino , Fragilidade/etiologia , Fragilidade/prevenção & controle , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/patologia
3.
J Urol ; 205(1): 174-182, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856988

RESUMO

PURPOSE: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience. MATERIALS AND METHODS: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included. RESULTS: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (6.3%/12.5%) and mucus obstruction (0.0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (chi-squared 11.227, p <0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p <0.05). CONCLUSIONS: The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate.


Assuntos
Íleo/cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Incontinência Urinária/epidemiologia , Coletores de Urina/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cistectomia/efeitos adversos , Feminino , Seguimentos , Humanos , Incidência , Tampões Absorventes para a Incontinência Urinária/estatística & dados numéricos , Cateterismo Uretral Intermitente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/patologia , Derivação Urinária/métodos , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Adulto Jovem
4.
Anesthesiology ; 133(2): 293-303, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33377959

RESUMO

BACKGROUND: Postoperative ileus is a common complication of intraabdominal surgeries, including radical cystectomy with reported rates as high as 32%. Perioperative fluid administration has been associated with improvement in postoperative ileus rates, but it is difficult to generalize because earlier studies lacked standardized definitions of postoperative ileus and other relevant outcomes. The hypothesis was that targeted individualized perioperative fluid management would improve postoperative ileus in patients receiving radical cystectomy. METHODS: This is a parallel-arm, double-blinded, single-center randomized trial of goal-directed fluid therapy versus standard fluid therapy for patients undergoing open radical cystectomy. The primary outcome was postoperative ileus, and the secondary outcome was complications within 30 days post-surgery. Participants were at least 21 yr old, had a maximum body mass index of 45 kg/m2 and no active atrial fibrillation. The intervention in the goal-directed therapy arm combined preoperative and postoperative stroke volume optimization and intraoperative stroke volume variation minimization to guide fluid administration, using advanced hemodynamic monitoring. RESULTS: Between August 2014 and April 2018, 283 radical cystectomy patients (142 goal-directed fluid therapy and 141 standard fluid therapy) were included in the analysis. Postoperative ileus occurred in 25% (36 of 142) of patients in the goal-directed fluid therapy arm and 21% (30 of 141) of patients in the standard arm (difference in proportions, 4.1%; 95% CI, -5.8 to 13.9; P = 0.418). There was no difference in incidence of high-grade complications between the two arms (20 of 142 [14%] vs. 23 of 141 [16%]; difference in proportions, -2.2%; 95% CI, -10.6 to 6.1; P = 0.602), with the exception of acute kidney injury, which was more frequent in the goal-directed fluid therapy arm (56% [80 of 142] vs. 40% [56 of 141] in the standard arm; difference in proportions, 16.6%; 95% CI, 5.1 to 28.1; P = 0.005; P = 0.170 after adjustment for multiple testing). CONCLUSIONS: Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy.


Assuntos
Cistectomia/efeitos adversos , Hidratação/métodos , Objetivos , Íleus/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Idoso , Método Duplo-Cego , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Volume Sistólico , Resultado do Tratamento
5.
Urologiia ; (5): 54-60, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185348

RESUMO

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. AIM: To describe the main stages of RARC and to analyze its short-term results. MATERIALS AND METHODS: RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. RESULTS: The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. CONCLUSION: RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Estruturas Criadas Cirurgicamente , Neoplasias da Bexiga Urinária , Derivação Urinária , Cistectomia/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos
6.
Medicine (Baltimore) ; 99(43): e22893, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120837

RESUMO

Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those ≥45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those ≥65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy.This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration ≥0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis.MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010).MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.


Assuntos
Cistectomia/efeitos adversos , Isquemia Miocárdica/etiologia , Troponina I/sangue , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Cistectomia/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/metabolismo , Estadiamento de Neoplasias/métodos , Complicações Pós-Operatórias/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/patologia
9.
Adv Clin Exp Med ; 29(7): 857-863, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32725972

RESUMO

BACKGROUND: Evaluating health-related quality of life (HR-QoL) is important in urological oncology. OBJECTIVES: To evaluate the impact of minimally invasive radical cystectomy (RC) on the patients' QoL depending on the surgical strategy (laparoscopic compared to robotic). MATERIAL AND METHODS: The study involved 110 patients divided into 2 groups: group 1 (n = 65), qualified for robotic-assisted RC (RARC), and group 2 (n = 45), qualified for laparoscopic RC (LRC). A prospective analysis of QoL was performed. In the study, we used sociodemographic data taken from the patients' medical records, and data from standardized questionnaires of QoL surveys entitled Functional Assessment of Cancer Therapy - General (FACT-G) and Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-Bl). RESULTS: In the patients who had undergone LRC, a statistically significant difference in HR-QoL was noted only for the subjective well-being (SWB) domain regarding family and social life: The patients had higher SWB values before surgery than after it. In the patients who had undergone RARC, statistically significant differences in HR-QoL were noted in 3 domains: 1) SWB - family and social life, 2) FACT-Bl assessment and 3) FACT-G assessment. Both before and after surgery, no statistically significant differences were found between the 2 groups for any of the HR-QoL domains. CONCLUSIONS: The surgical technique of minimally invasive endoscopic RC used (laparoscopic or robotic) does not affect HR-QoL domains.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Cistectomia/efeitos adversos , Humanos , Complicações Pós-Operatórias , Estudos Prospectivos , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia
10.
J Urol ; 204(5): 982-988, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32469268

RESUMO

PURPOSE: We assessed the effect of enhanced recovery after surgery protocol related fluid restriction on kidney function and the incidence of postoperative acute kidney injury and 3-month kidney function. MATERIALS AND METHODS: In a retrospectively collected, single institution cohort we studied 296 consecutive patients (146 pre-enhanced recovery after surgery vs 150 enhanced recovery after surgery) who underwent radical cystectomy from 2010 to 2018. The primary outcome was the incidence of postoperative acute kidney injury. Secondary outcomes were length of hospital stay, time to bowel movements, time to tolerate regular diet, postoperative complications and 30-day readmission rate. Study limitations include its retrospective design and relatively modest sample size. RESULTS: We observed an increased rate of postoperative acute kidney injury in patients on the enhanced recovery after surgery protocol (42.7% vs 30.1%, OR 1.725, p=0.025). On multivariate analysis enhanced recovery after surgery protocol remained a significant predictor of acute kidney injury even when controlling for other covariates including baseline kidney function (OR 1.8, 95% CI 1.04-3.30, p=0.036). Patients with postoperative acute kidney injury demonstrated significantly higher odds of stage 3 chronic kidney disease at 3 months even after controlling for baseline renal function (OR 2.5, 95% CI 1.3-4.9, p=0.016). CONCLUSIONS: Use of an enhanced recovery after surgery protocol following radical cystectomy was associated with a higher risk of postoperative acute kidney injury in patients who had baseline chronic kidney disease which could be related to the restricted perioperative fluid management mandated by enhanced recovery after surgery. Use of the enhanced recovery after surgery protocol did not impact the length of hospital stay or readmission rates.


Assuntos
Lesão Renal Aguda/epidemiologia , Cistectomia/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada/normas , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Idoso , Ingestão de Líquidos/fisiologia , Feminino , Humanos , Incidência , Rim/fisiopatologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/cirurgia , Equilíbrio Hidroeletrolítico/fisiologia
11.
Anesthesiology ; 133(2): 293-303, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32472804

RESUMO

BACKGROUND: Postoperative ileus is a common complication of intraabdominal surgeries, including radical cystectomy with reported rates as high as 32%. Perioperative fluid administration has been associated with improvement in postoperative ileus rates, but it is difficult to generalize because earlier studies lacked standardized definitions of postoperative ileus and other relevant outcomes. The hypothesis was that targeted individualized perioperative fluid management would improve postoperative ileus in patients receiving radical cystectomy. METHODS: This is a parallel-arm, double-blinded, single-center randomized trial of goal-directed fluid therapy versus standard fluid therapy for patients undergoing open radical cystectomy. The primary outcome was postoperative ileus, and the secondary outcome was complications within 30 days post-surgery. Participants were at least 21 yr old, had a maximum body mass index of 45 kg/m and no active atrial fibrillation. The intervention in the goal-directed therapy arm combined preoperative and postoperative stroke volume optimization and intraoperative stroke volume variation minimization to guide fluid administration, using advanced hemodynamic monitoring. RESULTS: Between August 2014 and April 2018, 283 radical cystectomy patients (142 goal-directed fluid therapy and 141 standard fluid therapy) were included in the analysis. Postoperative ileus occurred in 25% (36 of 142) of patients in the goal-directed fluid therapy arm and 21% (30 of 141) of patients in the standard arm (difference in proportions, 4.1%; 95% CI, -5.8 to 13.9; P = 0.418). There was no difference in incidence of high-grade complications between the two arms (20 of 142 [14%] vs. 23 of 141 [16%]; difference in proportions, -2.2%; 95% CI, -10.6 to 6.1; P = 0.602), with the exception of acute kidney injury, which was more frequent in the goal-directed fluid therapy arm (56% [80 of 142] vs. 40% [56 of 141] in the standard arm; difference in proportions, 16.6%; 95% CI, 5.1 to 28.1; P = 0.005; P = 0.170 after adjustment for multiple testing). CONCLUSIONS: Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy.


Assuntos
Cistectomia/efeitos adversos , Hidratação/métodos , Objetivos , Íleus/terapia , Complicações Pós-Operatórias/terapia , Idoso , Cistectomia/tendências , Método Duplo-Cego , Feminino , Hidratação/tendências , Humanos , Íleus/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
12.
Arch Esp Urol ; 73(4): 316-319, 2020 May.
Artigo em Espanhol | MEDLINE | ID: mdl-32379067

RESUMO

OBJECTIVE: Despite the high frequency of complications after a radical cystoprostatectomy, the presence of a fistula that communicates the external iliac artery and the ureteroileostomy has not been described in the medical literature. We present the diagnosis and medical management of a massive hemorrhage through the Bricker´s ostomy due to an external iliac artery´s mycotic aneurysm  fistulized to the ureteroileostomy. METHOD: A 78 years old patient under went laparoscopic radical cystoprostatectomy with Bricker-type urinary diversion due to muscle-invasive bladder cancer. During the immediate pos toperative period he presented different complications including sepsis caused by a pelvic collection. Due to a massive hemorrhage through Bricker´s ostomy he went to the emergency department where was diagnosed by CT of active bleeding from right external iliac artery to the interior of the ureteroileostomy. We decided to perform exploratory laparotomy showing an aneurysm with fistulous orifice communicating the medial external iliac artery to Bricker ureteroileostomy. A femoro-femoral bypass, ligation of two centimeters of the external iliac artery, closure of the Bricker´s orifice and right cutaneous ureterostomy was needed. RESULTS: After the surgery, the patient required renal replacement therapy and vasoactive drugs. Discharge from the hospital was 11 days after the intervention. CONCLUSIONS: The presence of an uncontrolled arterial fistula implies urgent care in a pathology such as the mycotic aneurysm that already constitutes a challenge. Fast diagnosis and surgical skills are essential to increase patient's survival chances.


Assuntos
Aneurisma Infectado , Laparoscopia , Derivação Urinária , Idoso , Cistectomia/efeitos adversos , Humanos , Artéria Ilíaca/cirurgia , Masculino
13.
Anaesthesia ; 75(7): 887-895, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32329060

RESUMO

We recorded the survival of 141 patients assessed for radical cystectomy, which included cardiopulmonary exercise testing. The median Kaplan-Meier survival estimates were: 1540 days for the whole cohort; 2200 days after cystectomy scheduled (n = 108); and 843 days without surgery. The mortality hazard remained double that expected for a matched general population, but survival was better in patients scheduled for surgery than those who were not: the mortality hazard ratio (95%CI) after cystectomy was 0.43 (0.26-0.73) the mortality hazard without surgery, p = 0.001. The mortality hazard ratios for the three-variable Bayesian Model Averaging survival model for all 141 patients were: referral for surgery (0.5); haemoglobin concentration (0.98); and efficiency of carbon dioxide output (1.05). Efficiency of carbon dioxide output was the single variable in the postoperative model (n = 108), mortality hazard 1.08 (per unit increase). The ratio of observed to expected peak oxygen consumption associated best with mortality in 33 patients not referred for surgery, hazard ratio 0.001. Our results can inform consultations with patients with invasive bladder cancer and suggest that interventions to increase fitness and haemoglobin may improve survival in patients who do and who do not undergo radical cystectomy.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono/fisiologia , Cistectomia/efeitos adversos , Inglaterra/epidemiologia , Teste de Esforço/métodos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Consumo de Oxigênio/fisiologia , Aptidão Física/fisiologia , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/fisiopatologia
14.
Int J Clin Oncol ; 25(7): 1385-1392, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32306131

RESUMO

BACKGROUND: The incidence of atypical oncologic failure in patients with bladder cancer, including peritoneal carcinomatosis, and recurrences at the port site and soft tissue after laparoscopic and robot-assisted radical cystectomy are not well characterized. METHODS: We retrospectively reviewed the records of 52, 51, and 12 patients who underwent open, laparoscopic, and robot-assisted radical cystectomy, respectively, for bladder cancer from 2007 to 2018 at our institution. We identified techniques associated with atypical oncologic failure. RESULTS: The median follow-up period was 29 months. Among the 115 patients, 29 (25%) experienced oncological recurrences, and 7 (6%), 12 (10%), and 23 (20%) had atypical, local, and distant recurrences, respectively. The laparoscopic and robot-assisted radical cystectomy groups had significantly higher incidences of total atypical oncologic failure than the open radical cystectomy group (p = 0.013), including six, one, and two patients with peritoneal carcinomatosis, port site carcinomatosis, and soft tissue involvement, respectively. All 7 patients with atypical oncologic failure died of cancer; the median time from surgery to death was 9.3 months. All these patients were cT â‰§ 3 and had grade 3 disease. In three patients (43%), the pathological tissue contained variants other than urothelial carcinoma. Five (71%) were among the initial twenty patients. Four patients (57%) had histories of intraoperative urine spillage or bladder perforation during transurethral resection. CONCLUSIONS: Patients with cT â‰§ 3 stage, with pathological variants other than urothelial carcinoma, and those undergoing procedures that lead to extravesical dissemination should avoid laparoscopic radical cystectomy when the procedures are first introduced.


Assuntos
Cistectomia/efeitos adversos , Laparoscopia/efeitos adversos , Neoplasias Peritoneais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Falha de Tratamento , Neoplasias da Bexiga Urinária/patologia
16.
Adv Ther ; 37(5): 2159-2168, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32200536

RESUMO

INTRODUCTION: Ovarian endometriosis is the most common type of endometriosis (EM), affecting more than 40% of women with EM. Currently, surgical intervention is still controversial in infertile patients with ovarian endometriosis, especially in those with stage III-IV EM. Very few studies have been done to analyze long-term pregnancy results in patients with endometrioma more than 5 years after surgery. Therefore, the aim of this study was to explore the pregnancy outcomes and the related factors in patients with endometrioma and stage III-IV endometriosis during a long-term follow-up postoperatively. METHODS: We collected 347 patients with ovarian endometriosis, which included 59 infertile patients with stage III-IV endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing laparoscopic excision of ovarian endometriomas performed by a single doctor at the Peking Union Medical College Hospital from January 2009 to April 2013. RESULTS: A total of 59 infertile patients were recruited. The mean age was 31.8 ± 3.6 years. The mean size of the endometriomas was 6.8 ± 3.3 cm. Before surgery, dysmenorrhea was present in 88.1% (52/59) of the cases, while chronic pelvic pain was reported in nine cases (15.3%). A total of 20.3% (12/59) of cases were concurrent with leiomyoma, 52.5% (31/59) with deep infiltrating endometriosis (DIE), and 39.0% (23/59) with adenomyosis. During laparoscopy, 21 cases were diagnosed as stage III (35.6%) and 38 as stage IV (64.4%) EM according to the revised American Fertility Society (AFS) classification. After laparoscopic cystectomy, 38 (64.4%) patients became successfully pregnant by the 5th year. All the patients were divided into two groups according to the postoperative pregnancy outcomes. In univariate analysis, the higher mean age and concurrent diagnosis of adenomyosis were seen to be related to poor postoperative pregnancy outcomes (p < 0.05). In multivariate analysis, however, the mean age, chronic pelvic pain (CPP), and adenomyosis were independent risk factors of pregnancy outcomes between the two groups (p < 0.05). With a minimum follow-up of 6 years, 23.7% (14/59) of recurrence was observed in the entire study cohort. CONCLUSION: Infertile patients with endometrioma and stage III-IV EM may have lower pregnancy rates after laparoscopic cystectomy if they are older and present with CPP and adenomyosis. Our data showed a lower rate of recurrence but a higher rate of pregnancy after surgery.


Assuntos
Cistectomia/efeitos adversos , Endometriose/complicações , Endometriose/cirurgia , Infertilidade Feminina/etiologia , Laparoscopia/efeitos adversos , Recidiva Local de Neoplasia/etiologia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/cirurgia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Gravidez , Taxa de Gravidez
17.
J Robot Surg ; 14(6): 805-812, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32152900

RESUMO

The objective of this systematic review is to evaluate the current evidence regarding atypical metastases in patients undergoing robotic-assisted radical cystectomy (RARC). A review of the current literature was conducted through the Medline and NCBI PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases in October 2019. From the literature search using the cited keys and after a careful evaluation of the full texts, we included 31 articles in the study. Fourteen studies (45.2%) reported at least an atypical recurrence during the follow-up period with a rate between 4 and 40% of all the recurrences. Overall, 105 (1.63%) of the 6720 patients who have been evaluated in the included studies developed an atypical recurrence. Sixty-three (60%) of these atypical metastases were peritoneal carcinomatosis, 16 (15.2%) extrapelvic lymph nodes metastases, 11 (10.5%) port-site metastases, 10 (9.5%) retroperitoneal nodal metastases, while 5 (3.8%) patients developed more than one type of atypical recurrence. In literature, there is a low but not negligible incidence of atypical recurrences after RARC. However, publication bias and retrospective design of most studies could influence the evidences. Further prospective randomized studies are needed to clarify the real risk of patients undergoing RARC to develop atypical metastases.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/efeitos adversos , Metástase Linfática , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Peritoneais/secundário , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Carcinoma de Células de Transição/secundário , Cistectomia/métodos , Humanos , Neoplasias Peritoneais/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/patologia
18.
Am Surg ; 86(2): 95-103, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167059

RESUMO

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Preoperative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.


Assuntos
Cistectomia/efeitos adversos , Fragilidade/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cistectomia/mortalidade , Cistectomia/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Fragilidade/complicações , Fragilidade/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Valor Preditivo dos Testes , Protectomia/mortalidade , Protectomia/estatística & dados numéricos , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
World J Surg Oncol ; 18(1): 33, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041630

RESUMO

OBJECTIVE: To ascertain whether en bloc resection could reduce the risk of seeding cancer cells into the circulation during the resection of non-muscle invasive bladder cancer (NMIBC). METHODS: Patients with primary NMIBC were enrolled in this prospective study from October 2017 to May 2018. Patients were allocated to receive conventional transurethral resection of the bladder (TURB) or retrograde en bloc resection technique of the bladder tumor (RERBT). Blood samples (1 ml) for circulating tumor cell (CTC) enumeration were drawn from the peripheral vein prior to resection (PV1), immediately after resection of the tumor base (PV2), and at 12 h after resection (PV3). Intra-group comparisons of the changes in the number of CTCs identified among the PV1, PV2, and PV3 blood samples were performed in each group. RESULTS: A total of 21 patients (12 in the RERBT group and 9 in the TURB group) were recruited. For patients receiving TURB, the level of CTCs identified in PV3 was significantly higher than that in PV1 (p = 0.047). However, there was no significant difference in CTC counts before and after resection in the RERBT group. CONCLUSION: RERBT did not increase the number of tumor cells in the bloodstream.


Assuntos
Cistectomia/métodos , Inoculação de Neoplasia , Células Neoplásicas Circulantes/patologia , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/patologia , Contagem de Células , Cistectomia/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/sangue , Neoplasias da Bexiga Urinária/patologia
20.
Oncology ; 98(3): 161-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31962315

RESUMO

BACKGROUND: The effect of anesthetic techniques on cancer recurrence has been the subject of intensive research in the past years, as it affects a large proportion of the population. The use of opioids and halogenated agents in cancer patients during the perioperative period may be related to higher rates of cancer recurrence and reduced disease-free survival. METHODS: This was a prospective study. The sample was composed of 100 patients who underwent a radical cystectomy for infiltrating bladder cancer in a reference center. We compared disease-free survival associated with combined anesthesia versus opiate-based analgesia. The relationship between the administered hypnotic and disease-free survival was also investigated. RESULTS: The median disease-free survival of the patients who received combined anesthesia was 585 (240-1,005) days versus 210 (90-645) days in the other group. A significant difference was observed between the two groups (p = 0.01). Combined analysis of all groups revealed significant differences in disease-free survival between patients who received combined anesthesia with propofol (510 [315-1,545] disease-free days) and those who received sevoflurane and opioids (150 [90-450] disease-free days) (p = 0.02). CONCLUSIONS: Anesthesia may play a crucial role in tumor relapse, as it is administered at the moment of the greatest risk of dissemination: surgical handling of the tumor. Opioids and volatile agents have been related to an increased risk for cancer recurrence. We compared the use of propofol + local anesthesia versus sevoflurane + opioids and also found that disease-free survival was longer among patients who received propofol + local anesthesia. Disease-free survival increases with the use of propofol in combination with epidural anesthesia in patients who undergo surgery for infiltrating bladder cancer.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia por Inalação , Anestesia Intravenosa , Anestésicos Intravenosos/administração & dosagem , Cistectomia , Propofol/administração & dosagem , Neoplasias da Bexiga Urinária/cirurgia , Analgésicos Opioides/efeitos adversos , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/mortalidade , Anestesia Intravenosa/efeitos adversos , Anestesia Intravenosa/mortalidade , Anestésicos Intravenosos/efeitos adversos , Cistectomia/efeitos adversos , Cistectomia/mortalidade , Intervalo Livre de Doença , Humanos , Metástase Neoplásica , Recidiva Local de Neoplasia , Propofol/efeitos adversos , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
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