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?
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The aim of this study was to examine preoperative patients’ characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications.
In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011’ (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates.
Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3 % received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p < 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p < 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers.
Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.
KeywordsRadical Cystectomy Urinary Diversion Multivariable Logistic Regression Analysis Prostatic Urethra MIBC
The authors would like to thank their colleagues for their valuable effort in the acquisition of data within our collaborative research group, PROMETRICS 2011.
Marianne Schmid certifies that there are no conflicts of interest, including specific financial interests and relationships and affiliations, relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending).
- 1.International Agency for Research on Cancer, World Health Organisation. GLOBOCAN 2008: cancer incidence, mortality, prevalence and disability-adjusted life years (DALY’s) worldwide in 2008. Lyon: IARC Press; 2010.Google Scholar
- 6.Hautmann RE, de Petriconi RC, Volkmer BG. Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol. 2010;184(3):990-994; quiz 1235.Google Scholar
- 7.Hollenbeck BK, Miller DC, Taub D, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol. 2005;174(4 Pt 1):1231-1237; discussion 1237.Google Scholar
- 9.Lowrance WT, Rumohr JA, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Contemporary open radical cystectomy: analysis of perioperative outcomes. J Urol. 2008;179(4):1313-1318; discussion 1318.Google Scholar
- 10.Takada N, Abe T, Shinohara N, et al. Peri-operative morbidity and mortality related to radical cystectomy: a multi-institutional retrospective study in Japan. BJU Int. 2012;110(11 Pt B):E756-764.Google Scholar
- 18.K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.Google Scholar
- 19.Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
- 32.Stein JP, Penson DF, Lee C, Cai J, Miranda G, Skinner DG. Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer. J Urol. 2009;181(5):2052-2058; discussion 2058-2059.Google Scholar
- 35.Leow JJ, Reese S, Trinh QD, et al. The impact of surgeon volume on the morbidity and costs of radical cystectomy in the United States: a contemporary population-based analysis. BJU Int. Epub 27 Mar 2014. doi: 10.1111/bju.12749.
- 38.Akkad T, Gozzi C, Deibl M, et al. Tumor recurrence in the remnant urothelium of females undergoing radical cystectomy for transitional cell carcinoma of the bladder: long-term results from a single center. J Urol. 2006;175(4):1268-1271; discussion 1271.Google Scholar