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.
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.
Authors: Firas Abdollah; Maxine Sun; Jan Schmitges; Rodolphe Thuret; Orchidee Djahangirian; Claudio Jeldres; Zhe Tian; Shahrokh F Shariat; Paul Perrotte; Francesco Montorsi; Pierre I Karakiewicz Journal: Ann Surg Oncol Date: 2011-02-23 Impact factor: 5.344
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Authors: Bernard H Bochner; Guido Dalbagni; Daniel D Sjoberg; Jonathan Silberstein; Gal E Keren Paz; S Machele Donat; Jonathan A Coleman; Sheila Mathew; Andrew Vickers; Geoffrey C Schnorr; Michael A Feuerstein; Bruce Rapkin; Raul O Parra; Harry W Herr; Vincent P Laudone Journal: Eur Urol Date: 2014-12-08 Impact factor: 20.096
Authors: Simon P Kim; Nilay D Shah; Christopher J Weight; R Houston Thompson; Jeffrey K Wang; R Jeffrey Karnes; Leona C Han; Jeanette Y Ziegenfuss; Igor Frank; Matthew K Tollefson; Stephen A Boorjian Journal: BJU Int Date: 2013-03-01 Impact factor: 5.588
Authors: Marianne Schmid; Michael Rink; Miriam Traumann; Patrick J Bastian; Georg Bartsch; Jörg Ellinger; Marc-Oliver Grimm; Boris Hadaschik; Axel Haferkamp; Oliver W Hakenberg; Atiqullah Aziz; Florian Hartmann; Edwin Herrmann; Markus Hohenfellner; Günter Janetschek; Michael Gierth; Sasc ha Pahernik; Chris Protzel; Jan Roigas; Murat Gördük; Lukas Lusuardi; Matthias May; Quoc-Dien Trinh; Margit Fisch; Felix K H Chun Journal: Ann Surg Oncol Date: 2014-08-28 Impact factor: 5.344