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Single staff cystectomy in a low-volume center: Oncological outcomes and complications
Author(s) -
Philipp Baumeister,
Davide Galioto,
Marco Moschini,
Chiara Lonati,
Stefania Zamboni,
Luca Afferi,
Patrick Stucki,
Hansjörg Danuser,
Dirk Lehnick,
Livio Mordasini,
Agostino Mattei
Publication year - 2021
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.7171
Subject(s) - medicine , cystectomy , urinary diversion , perioperative , interquartile range , dissection (medical) , surgery , bladder cancer , lymph node , urology , cancer
Radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) is a complex surgical procedure, associated with substantial perioperative complications. Previous studies suggested reserving it to high-volume centers in order to improve oncological and perioperative outcomes. However, only limited data exist regarding low-volume centers with highly experienced surgeons. We aimed to assess oncological and perioperative outcomes after RC performed by experienced surgeons in the low-volume center of Luzerner Kantonsspital, Lucerne, CH. Methods: We retrospectively analyzed data of 158 patients who underwent RC and PLND performed between 2009 and 2019 at a single low-volume center by three experienced surgeons, each having performed at least 50 RCs. Complications were graded according to the 2004 modified Clavien-Dindo grading system. Results: A total of 110 patients (70%) received an incontinent urinary diversion (ileal conduit or ureterocutaneostomy) and 48 patients (30%) received a continent urinary diversion (ileal orthotopic neobladder, ureterosigmoidostomy, or Mitrofanoff pouch). Median operating time was 419 minutes (interquartile range [IQR] 346–461). Overall, at RC specimen, 71.5% of patients had urothelial carcinoma ,12.6% squamous, 3.1% sarcomatoid, 1.2%glandular, and 0.6% small cell carcinoma. Median number of lymph nodes removed was 23 (IQR 16–29.5). Positive margins were found in eight patients (5.1%). Overall, five-year survival rate was 52.4%. The complication rate was 56.3%: 143 complications were found in 89 patients, 36 (22.8%) with Clavien ≥3. The 30-day mortality rate was 2.5%. Conclusions: RC could be safely performed in a low-volume center by experienced surgeons with comparable outcomes to high-volume centers.

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