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Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
Department of Urology, University Hospital, Örebro, Sweden.ORCID-id: 0000-0003-4615-5238
Dept Surg & Urol, Danderyd Hosp, Danderyd, Sweden.
Region Örebro län. Department of Urology, Örebro University Hospital, Örebro, Sweden.
Dept Urol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
Vise andre og tillknytning
2014 (engelsk)Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, nr 4, s. 334-340Artikkel i tidsskrift (Fagfellevurdert) 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.

sted, utgiver, år, opplag, sider
Informa Healthcare, 2014. Vol. 48, nr 4, s. 334-340
Emneord [en]
Bladder carcinoma, complications, radical cystectomy
HSV kategori
Identifikatorer
URN: urn:nbn:se:oru:diva-56495DOI: 10.3109/21681805.2014.909883ISI: 000340072700001PubMedID: 24844275Scopus ID: 2-s2.0-84904320467OAI: oai:DiVA.org:oru-56495DiVA, id: diva2:1082440
Tilgjengelig fra: 2017-03-16 Laget: 2017-03-16 Sist oppdatert: 2019-04-01bibliografisk kontrollert
Inngår i avhandling
1. Clinical aspects of cystectomy and urinary diversion
Åpne denne publikasjonen i ny fane eller vindu >>Clinical aspects of cystectomy and urinary diversion
2019 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
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

sted, utgiver, år, opplag, sider
Örebro: Örebro University, 2019. s. 91
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 190
Emneord
Bladder cancer, urinary diversion, orthotopic neobladder substitution, postoperative complications, neoadjuvant chemotherapy, induction chemotherapy
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-72379 (URN)978-91-7529-275-5 (ISBN)
Disputas
2019-04-26, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2019-02-11 Laget: 2019-02-11 Sist oppdatert: 2019-04-10bibliografisk kontrollert

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