Advertisement

Factors influencing intraoperative conversion from planned orthotopic to non-orthotopic urinary diversion during radical cystectomy

  • Saum Ghodoussipour
  • Nariman Ahmadi
  • Natalie Hartman
  • Giovanni Cacciamani
  • Gus Miranda
  • Jie Cai
  • Anne Schuckman
  • Hooman Djaladat
  • Inderbir Gill
  • Siamak Daneshmand
  • Mihir Desai
Original Article
  • 19 Downloads

Abstract

Objectives

To determine and investigate the intraoperative factors that contribute to a change in plan from continent orthotopic neobladder to ileal conduit or continent cutaneous diversion at the time of radical cystectomy.

Subjects and methods

A retrospective review of our prospectively maintained bladder cancer database was performed. Of the 711 patients who underwent radical cystectomy from 2012 to 2016, 387 (54.4%) had given consent to have a NB. Of these 387 patients, 348 (89.9%) ultimately received a neobladder while 34 (8.8%) received an ileal conduit and 5 (1.3%) continent cutaneous diversion. The factors involved in the intraoperative change of plan were examined in this study.

Results

Patients who ultimately received a neobladder were significantly more likely to have clinical node-negative disease (p = 0.045), negative soft tissue margins (p = 0.001), lower body mass index (p = 0.045) and higher volume surgeons (p < 0.001). Oncologic reasons for intraoperative conversions were more common than technical reasons (58.3% vs 35.9%), in both robotic and open surgical techniques. The choice of surgical approach (open vs robotic) did not influence the rate of intraoperative conversion.

Conclusion

The factors influencing intraoperative decision not to perform neobladder are predominantly oncologic rather than technical. A clear understanding of the factors involved in influencing the intraoperative change in the urinary diversion plan may improve shared decision making in patients undergoing radical cystectomy in the future.

Keywords

Radical cystectomy Urinary diversion Orthotopic neobladder Ileal conduit 

Notes

Author contributions

SG: protocol/project development, data collection or management, data analysis, manuscript writing/editing. NA: protocol/project development, data collection or management, data analysis, manuscript writing/editing. NH: protocol/project development, data collection or management, data analysis, manuscript writing/editing. GC: Data collection or management, data analysis, manuscript writing/editing. GM: data collection or management, data analysis. JC: data analysis. Schukman: protocol/project development, manuscript writing/editing. HD: protocol/project development, manuscript writing/editing. IG: protocol/project development, manuscript writing/editing. SD: protocol/project development, manuscript writing/editing. MD: protocol/project development, manuscript writing/editing.

Funding

None.

Compliance with ethical standards

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S et al (2014) Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 113(1):11–23CrossRefGoogle Scholar
  2. 2.
    Ashley MS, Daneshmand S (2010) Factors influencing the choice of urinary diversion in patients undergoing radical cystectomy. BJU Int 106(5):654–657CrossRefGoogle Scholar
  3. 3.
    Pak JS, Lee JJ, Bilal K, Finkelstein M, Palese MA (2017) Utilization trends and short-term outcomes of robotic versus open radical cystectomy for bladder cancer. Urology 103:117–123CrossRefGoogle Scholar
  4. 4.
    Kim SP, Shah ND, Weight CJ, Thompson RH, Wang JK, Karnes RJ et al (2013) Population-based trends in urinary diversion among patients undergoing radical cystectomy for bladder cancer. BJU Int 112(4):478–484CrossRefGoogle Scholar
  5. 5.
    Stein JP, Skinner DG (2004) Surgical atlas. Radical cystectomy. BJU Int 94(1):197–221CrossRefGoogle Scholar
  6. 6.
    Chopra S, de Castro Abreu AL, Berger AK, Sehgal S, Gill I, Aron M et al (2017) Evolution of robot-assisted orthotopic ileal neobladder formation: a step-by-step update to the University of Southern California (USC) technique. BJU Int 119(1):185–191CrossRefGoogle Scholar
  7. 7.
    Hedgepeth RC, Gilbert SM, He C, Lee CT, Wood DP Jr (2010) Body image and bladder cancer specific quality of life in patients with ileal conduit and neobladder urinary diversions. Urology 76(3):671–675CrossRefGoogle Scholar
  8. 8.
    Kretschmer A, Grimm T, Buchner A, Grabbert M, Jokisch F, Schneevoigt BS et al (2017) Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications. World J Urol 35(8):1223–1231CrossRefGoogle Scholar
  9. 9.
    Schmid M, Rink M, Traumann M, Bastian PJ, Bartsch G, Ellinger J et al (2015) Evidence from the ‘prospective multicenter radical cystectomy series 2011 (PROMETRICS 2011)’ study: how are preoperative patient characteristics associated with urinary diversion type after radical cystectomy for bladder cancer? Ann Surg Oncol 22(3):1032–1042CrossRefGoogle Scholar
  10. 10.
    Somani BK, Gimlin D, Fayers P, N’Dow J (2009) Quality of life and body image for bladder cancer patients undergoing radical cystectomy and urinary diversion—a prospective cohort study with a systematic review of literature. Urology 74(5):1138–1143CrossRefGoogle Scholar
  11. 11.
    Daneshmand S, Bartsch G (2011) Improving selection of appropriate urinary diversion following radical cystectomy for bladder cancer. Expert Rev Anticancer Ther 11(6):941–948CrossRefGoogle Scholar
  12. 12.
    Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM et al (2015) Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol 67(6):1042–1050CrossRefGoogle Scholar
  13. 13.
    Abdollah F, Sun M, Schmitges J, Thuret R, Djahangirian O, Jeldres C et al (2011) Surgical caseload is an important determinant of continent urinary diversion rate at radical cystectomy: a population-based study. Ann Surg Oncol 18(9):2680–2687CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Saum Ghodoussipour
    • 1
  • Nariman Ahmadi
    • 1
  • Natalie Hartman
    • 1
  • Giovanni Cacciamani
    • 1
  • Gus Miranda
    • 1
  • Jie Cai
    • 1
  • Anne Schuckman
    • 1
  • Hooman Djaladat
    • 1
  • Inderbir Gill
    • 1
  • Siamak Daneshmand
    • 1
  • Mihir Desai
    • 1
  1. 1.USC Institute of Urology, Keck Medicine of USCUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations