Abstract
Purpose
To assess how trends in urinary diversion (UD) type following radical cystectomy (RC) have changed in recent years and investigate pre-operative predictors of UD type.
Methods
Data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2011 to 2015. We quantified the percentages of continent diversions (CD) versus incontinent diversions (ID) completed over this time frame. Using univariate and multivariable logistic regression analyses, we compared UD type across year of operation as well as predictors of type of diversion.
Results
We identified 4790 patients in the cohort, of which 81% underwent an incontinent diversion. Patients undergoing incontinent diversions were older (p < 0.001), more likely to be female (p < 0.001), had higher American Society of Anesthesiologists (ASA) classification (p < 0.001) and had more comorbidities with worse preoperative lab values. On multivariable analysis, the odds of incontinent diversion increased per year (OR 1.16, 95% CI 1.06–1.26; p = 0.001). Neoadjuvant chemotherapy (NAC) was associated with lower odds of receiving an ID (OR 0.33, 95% CI 0.17–0.64; p = 0.001). Being male, healthy and young were associated with higher odds of CD.
Conclusion
We demonstrate that there has been a decrease in continent diversion use in recent years. Neoadjuvant chemotherapy, proxies of life expectancy and gender are significant predictors of continent diversion. Further investigation to determine the underlying cause of decreased utilization of CD is warranted.
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References
Siegel R, Naishadham D, Jemal A (2012) Cancer Statistics. CA Cancer J Clin 62(1):10–29
Stenzl A, Cowan NC, De Santis M et al (2011) Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 59(6):1009–1018
Nieuwenhuijzen JA, de Vries RR, Bex A et al (2008) Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions. Eur Urol 53(4):834–844
Lee RK, Abol-Enein H, Artibani W et al (2014) Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 113(1):11–23
Ali AS, Hayes MC, Birch B, Dudderidge T, Somani BK (2015) Health related quality of life (HRQoL) after cystectomy: comparison between orthotopic neobladder and ileal conduit diversion. Eur J Surg Oncol 41(3):295–299
Ghosh A, Somani BK (2016) Recent trends in postcystectomy health-related quality of life (QoL) favors neobladder diversion: systematic review of the literature. Urology 93:22–26
Gore JL, Litwin MS, Urologic Diseases in America Project (2009) Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 27(1):45–50
Kim SP, Shah ND, Weight CJ et al (2013) Population-based trends in urinary diversion among patients undergoing radical cystectomy for bladder cancer. BJU Int 112(4):478–484
Gore JL, Saigal CS, Hanley JM, Schonlau M, Litwin MS (2006) Variations in reconstruction after radical cystectomy. Cancer 107(4):729–737. https://doi.org/10.1002/cncr.22058
Silberstein JL, Poon SA, Maschino AC et al (2013) Urinary diversion practice patterns among certifying American Urologists. J Urol 189(3):1042–1047
Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY (2009) Does surgical quality improve in the american college of surgeons national surgical quality improvement program. Ann Surg 250:7–20
ACS National Surgical Quality Improvement Program. American College of Surgeons. https://www.facs.org/quality-programs/acs-nsqip. Accessed August 10, 2017
Sun M, Trinh Q-D, Bianchi M et al (2014) Extent of lymphadenectomy does not improve the survival of patients with renal cell carcinoma and nodal metastases: biases associated with the handling of missing data urological oncology. BJU Int 113:36–42
Lowrance WT, Rumohr JA, Clark PE, Chang SS, Smith JA, Cookson MS (2009) Urinary diversion trends at a high volume, single American Tertiary Care Center. J Urol 182(5):2369–2375
Smith AB, Crowell K, Woods ME et al (2017) Functional outcomes following radical cystectomy in women with bladder cancer: a systematic review. Eur Urol Focus 3(1):136–143
Garg T, Chen LY, Kim PH, Zhao PT, Herr HW, Donat SM (2014) Preoperative serum albumin is associated with mortality and complications after radical cystectomy. BJU Int 113(6):918
Fischer-Valuck BW, Rao YJ, Rudra S, et al (2017). Treatment patterns and overall survival outcomes of octogenarians with muscle-invasive cancer of the bladder: an analysis of the national cancer database. J Urol. https://doi.org/10.1016/j.juro.2017.08.086
Hautmann RE, Abol-Enein H, Lee CT et al (2015) Urinary diversion: how experts divert. Urology 85:233–238
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Bachour, K., Faiena, I., Salmasi, A. et al. Trends in urinary diversion after radical cystectomy for urothelial carcinoma. World J Urol 36, 409–416 (2018). https://doi.org/10.1007/s00345-017-2169-3
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DOI: https://doi.org/10.1007/s00345-017-2169-3