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Jerlström, T. (2019). Clinical aspects of cystectomy and urinary diversion. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Clinical aspects of cystectomy and urinary diversion
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore different aspects of treatment of advanced urinary bladder cancer with radical cystectomy, pelvic lymph node dissection, and urinary diversion. Surgery that carry a high risk of complications as well as mortality. Aside from complications and risk of recurrance, patients have to cope with lifelong postoperative changes of body function, including sexual function, and body image, all affecting quality of life (QoL). The thesis comprises four papers. In the first paper, we compared functional outcome and QoL following two types of ileal orthotopic neobladder substitution. The results suggest that the S-shaped substitute entails better functional results than the U-shaped substitute, with better continence, especially at night. There was no difference in QoL. The second paper reports results from the first year of registration in the nation-wide Swedish Cystectomy Register. Analysis of risk factors for complications showed that high age and prolonged operation are associated with increased risk of short-term complications. The third paper investigated whether preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC) affects the risk of shortterm complications after radical cystectomy, using data from the Cystectomy Register covering 1340 patients of whom 39 percent received preoperativevchemotherapy. We found no such increase in risk. In the fourth paper, we analysed the results of a validation study of the Cystectomy Register. The validation showed 17 percent more low grade complications, three percent more high grade complications, and five percent more readmissions, within 90 days of surgery. Hence, a third-party validation may improve the validity of the register

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 91
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 190
Keywords
Bladder cancer, urinary diversion, orthotopic neobladder substitution, postoperative complications, neoadjuvant chemotherapy, induction chemotherapy
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-72379 (URN)978-91-7529-275-5 (ISBN)
Public defence
2019-04-26, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2019-02-11 Created: 2019-02-11 Last updated: 2019-04-10Bibliographically approved
Carlsson, J., Vikerfors, A., Frey, J., Jerlström, T. & Davidsson, S. (2019). Is soluble PD-L1 a potential biomarker for urothelial bladder cancer?. In: : . Paper presented at Keystone Symposia Conference 2019: Cancer metastasis: The role of metabolism, immunity and the microenvironment, Florens, Italy, March 15-19, 2019.
Open this publication in new window or tab >>Is soluble PD-L1 a potential biomarker for urothelial bladder cancer?
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-73843 (URN)
Conference
Keystone Symposia Conference 2019: Cancer metastasis: The role of metabolism, immunity and the microenvironment, Florens, Italy, March 15-19, 2019
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-04-17Bibliographically approved
Jerlström, T., Ruoqing, C., Liedberg, F., Andrén, O., Ströck, V., Aljabery, F. A. S., . . . Fall, K. (2019). No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study. World journal of urology
Open this publication in new window or tab >>No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study
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2019 (English)In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking.

METHODS: We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not.

RESULTS: Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82-1.39) or mortality (OR 0.75 95% CI 0.36-1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30-0.81).

CONCLUSION: This nation-wide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Bladder cancer, Induction chemotherapy, Neoadjuvant chemotherapy, Postoperative complications, Radical cystectomy
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-73968 (URN)10.1007/s00345-019-02770-2 (DOI)31020424 (PubMedID)
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-29Bibliographically approved
Liedberg, F., Hagberg, O., Aljabery, F., Gårdmark, T., Hosseini, A., Jahnson, S., . . . Holmberg, L. (2019). Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study. BJU International, 124(3), 449-456
Open this publication in new window or tab >>Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study
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2019 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, no 3, p. 449-456Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the association between hospital volume on overall survival (OS), cancer-specific survival (CSS), and quality of care defined as use of extended lymphadenectomy, continent reconstruction, neoadjuvant chemotherapy and treatment delay less than 3 months.

MATERIALS AND METHODS: We used Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent radical cystectomy for primary invasive bladder cancer stage T1-T3 in Sweden 1997-2014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level and neoadjuvant chemotherapy. PSMAV was either categorised in tertiles, dichotomised (at 25 or more cystectomies annually), or used as a continuous variable for every increase of 10 cystectomies annually.

RESULTS: PSMAV in the highest tertile (25 or more cystectomies annually) was associated with improved overall survival (HR 0.87, 95% CI 0.75-1.0), whereas corresponding HR for cancer-specific survival was 0.87 (95% CI 0.73-1.04). With PSMAV as a continuous variable, overall survival was improved for every increase of 10 cystectomies annually (HR 0.95, 95% CI 0.90-0.99). Moreover, higher PSMAV was associated with increased use of extended lymphadenectomy, continent reconstruction and neoadjuvant chemotherapy, but also more frequently with a treatment delay of more than 3 months after diagnosis.

CONCLUSIONS: The current study supports centralisation of radical cystectomy for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
Keywords
Bladder cancer, hospital volume, quality of care, radical cystectomy, survival
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-73581 (URN)10.1111/bju.14767 (DOI)000482452800019 ()30950568 (PubMedID)2-s2.0-85064609953 (Scopus ID)
Funder
Swedish Cancer Society, CAN 2016/470 CAN 2017/278
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-09-16Bibliographically approved
Liedberg, F., Hagberg, O., Aljabery, F., Gårdmark, T., Hosseini, A., Jahnson, S., . . . Holmberg, L. (2019). Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care in Sweden: a nationwide population-based study. Paper presented at 32nd NUF Congress, Reykjavik, Iceland, June 5-8, 2019. Scandinavian journal of urology, 53(Suppl. 221), 20-20
Open this publication in new window or tab >>Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care in Sweden: a nationwide population-based study
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2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no Suppl. 221, p. 20-20Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objective: To investigate the association between hospital volume on overall survival (OS), cancer-specific survival (CSS), and quality of care defined as use of extended lymphadenectomy, continent reconstruction, neoadjuvant chemotherapy and treatment delay less than 3 months.

Materials and Methods: We used Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent radical cystectomy for primary invasive bladder cancer stage T1T3 in Sweden 19972014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level and neoadjuvant chemotherapy. PSMAV was either categorised in tertiles, dichotomised (at 25 or more cystectomies annually), or used as a continuous variable for every increase of 10 cystectomies annually.

Results: PSMAV in the highest tertile (25 or more cystectomies annually) was associated with improved overall survival (HR 0.87, 95% CI 0.751.0), with a similar trend for cancer-specific survival (HR 0.87, 95% CI 0.731.04). With PSMAV as a continuous variable, overall survival was improved for every increase of 10 cystectomies annually (HR 0.95, 95% CI 0.900.99). Moreover, higher PSMAV was associated with increased use of extended lymphadenectomy, continent reconstruction and neoadjuvant chemotherapy, but also more frequently with a treatment delay of more than 3 months after diagnosis.

Conclusions: The current study supports centralisation of radical cystectomy for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-75253 (URN)000472734500041 ()
Conference
32nd NUF Congress, Reykjavik, Iceland, June 5-8, 2019
Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Böös, M., Jerlström, T., Beckman, E., Bläckberg, M., Brändstedt, J., Kollberg, P., . . . Liedberg, F. (2019). Who should record surgical complications?: Results from a third-party assessment of complications after radical cystectomy. Scandinavian journal of urology
Open this publication in new window or tab >>Who should record surgical complications?: Results from a third-party assessment of complications after radical cystectomy
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2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: In Sweden complications after radical cystectomy have been reported to the nationwide population-based Swedish Cystectomy Registry since 2011. Here, validation of the reporting was assessed in two healthcare regions.

Materials and methods: Complications were ascertained from patient records by a third party not involved in the care delivered to 429 randomly selected patients from 949 who had undergone radical cystectomy since 2011 in four hospitals. Without knowledge of the outcome in the primary registration, post-operative complications within 90 days post-operatively were assessed by an independent review of patient charts, and the results were compared with the primary reports in the Swedish Cystectomy Registry.

Results: The third-party assessment identified post-operative complications in 310 patients (72%). Low-grade complications (Clavien-Dindo I-II) were noted in 110 (26%) of the patients in the primary registration, but increased to 182 (42%) in the validation (p < 0.00001). High-grade complications (Clavien-Dindo III-V) were reported in 113 (26%) patients in the primary registration, but in 128 (30%) of the patients in the validation (p = 0.02). According to the third-party assessment, 18 patients (4%) had Clavien-Dindo grade IV complications and 12 (3%) died within 90 days of surgery (Clavien-Dindo grade V); corresponding values in the primary registration were 15 (3%) and 9 (2%), respectively. The readmission rate within 90 days increased from 27 to 32% in the validation (p < 0.00001).

Conclusions: Compared with registry data, third-party assessment revealed more complications and readmissions after radical cystectomy. Hence such evaluation may improve the validity of reported complication data.

Place, publisher, year, edition, pages
Informa Healthcare, 2019
Keywords
Clavien-Dindo, Third-party validation, bladder cancer, post-operative complications, radical cystectomy
National Category
Surgery Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-75818 (URN)10.1080/21681805.2019.1643912 (DOI)000480114400001 ()31385741 (PubMedID)
Funder
Swedish Cancer Society, 2017/278BioCARE - Biomarkers in Cancer Medicine Improving Health Care Education and Innovation
Note

Funding Agencies:

Lund Medical Faculty (ALF)  

Skåne University Hospital Research Funds  

Sten K. Johnson Foundation  

Krapperup Foundation  

Skåne County Council's Research and Development Foundation  REGSKANE-622351 

Gösta Jonsson Research Foundation  

Hillevi Fries Research Foundation 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-08-29Bibliographically approved
Jerlström, T., Gardmark, T., Carringer, M., Holmang, S., Liedberg, F., Hosseini, A., . . . Jahnson, S. (2014). Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database. Scandinavian journal of urology, 48(4), 334-340
Open this publication in new window or tab >>Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
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2014 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, no 4, p. 334-340Article in journal (Refereed) Published
Abstract [en]

Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.

Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.

Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.

Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
Keywords
Bladder carcinoma, complications, radical cystectomy
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-56495 (URN)10.3109/21681805.2014.909883 (DOI)000340072700001 ()24844275 (PubMedID)2-s2.0-84904320467 (Scopus ID)
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2019-04-01Bibliographically approved
Jerlström, T., Andersson, G. & Carringer, M. (2010). Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder. Scandinavian Journal of Urology and Nephrology, 44(4), 197-203
Open this publication in new window or tab >>Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
2010 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 4, p. 197-203Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare the functional outcome of two types of orthotopic bladder substitution, the S-shaped and the U-shaped neobladder, with respect to leakage, functional capacity and quality of life.

MATERIAL AND METHODS: Between 1999 and 2007, 45 male patients with urinary bladder cancer were treated with cystectomy and orthotopic bladder substitution; 23 with the S-shaped bladder ad modum Schreiter and 22 with the U-shaped bladder ad modum Studer. Patients were followed up by a urologist and a specialized nurse (urotherapist) at 1, 3 and 6 months. At each visit the patient completed a voiding chart, a weighted pad test and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Differences between the groups in functional outcome and quality of life variables were analysed by Student's t test using SPSS software.

RESULTS: Mean maximum bladder capacity increased over time. At 6 months, the S-bladder had a larger capacity than the U-bladder (525 ml vs 423 ml). Patients with an S-bladder had less urine leakage at all follow-ups, although this was statistically significant only at 6 months regarding day-time incontinence and at all visits regarding night-time incontinence. The mean urine leakage at 6 months was 7 g (day) and 30 g (night) in the S-bladder group and 50 g (day) and 250 g (night) in the U-bladder group. However, quality of life did not differ between the groups.

CONCLUSION: The S-bladder had better bladder capacity and less leakage than the U-bladder, but these differences did not translate into differences in quality of life. The results should be confirmed in larger prospective studies.

Place, publisher, year, edition, pages
Taylor & Francis, 2010
Keywords
Functional outcome, neobladder, orthotopic bladder substitution, quality of life, urinary leakage
National Category
Urology and Nephrology Nursing
Research subject
Medicine; Nursing Science
Identifiers
urn:nbn:se:oru:diva-35176 (URN)10.3109/00365591003727577 (DOI)000282143600001 ()20367221 (PubMedID)2-s2.0-77955538348 (Scopus ID)
Available from: 2014-05-27 Created: 2014-05-27 Last updated: 2019-04-09Bibliographically approved
Jerlström, T., Ruoqing, C., Liedberg, F., Ströck, V., Aljabery, F. A. .., Hosseini, A., . . . Fall, K.No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study.
Open this publication in new window or tab >>No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73417 (URN)
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
Böös, M., Jerlström, T., Beckman, E., Bläckberg, M., Brändstedt, J., Kollberg, P., . . . Liedberg, F.Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy.
Open this publication in new window or tab >>Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73418 (URN)
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4615-5238

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