scholarly journals What is the Urinary Diversion of Choice after Cystectomy in 2020?

2020 ◽  
Vol 8 ◽  
Author(s):  
Youssef Kharbach ◽  
Abdelhak Khallouk
Keyword(s):  
Bladder Cancer ◽  
Randomized Trial ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Underlying Disease ◽  
The State ◽  
Prospective Randomized Trial

Urinary diversion is often indicated after radical cystectomy for bladder cancer. It can either be non-continent or continent. Ileal conduit and orthotopic urinary diversions (neobladder) are by far the most commonly used diversions. The choice of the urinary diversion to be carried out is done on several levels in relation to the underlying disease, the state of the patient and the surgeon preference. It is inappropriate to make direct comparisons between enterocystoplasty and ileal conduit because of the differences in the choice of patients for each technique making a prospective randomized trial unlikely. The choice of the technique must be made after clearly informing and explaining explaining to the patient to enable him accept and adapt to his urinary diversion.

Adjuvant chemoradiotherapy after radical cystectomy in advanced high risk bladder cancer: A prospective randomized trial

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4545-4545 ◽  
Author(s):  
M. S. Zaghloul ◽  
H. M. Khaled ◽  
M. Lotayef ◽  
H. William
Keyword(s):  
Bladder Cancer ◽  
Risk Factor ◽  
High Risk ◽  
Randomized Trial ◽  
Radical Cystectomy ◽  
Locally Advanced ◽  
Prospective Randomized Trial ◽  
Adjuvant Chemoradiotherapy ◽  
Nodal Involvement ◽  
Pathological Stage

4545 Background: High risk locally advanced bladder cancer patients experienced low survival rates, high local recurrence and extensive distant metastasis. Postoperative radiotherapy (PORT) though improved the survival through improving local control. Methods: A prospective randomized trial was performed at NCI, Cairo, Egypt including 142 patients in 2 arms. Patients who underwent radical cystectomy and pelvic lymphadenectomy had to have one more of the following: P3b or P4a stage, G3 or involved lymphadenopathy. Arm I (71 patients) received PORT 45 G/30 fractions/3 weeks. Arm II (71 patients) received 2 courses of adjuvant chemotherapy (Gemcitabine 1 gm/m2 D1 and D8 and cisplatin 70 mg/m2 D2), same PORT regimen followed by another 2 courses of Gemcitabine-cisplatin. Results: Chemotherapy was tolerated with grade 1/2 toxicities. Early radiation reactions were also tolerable in both arms, slightly more in arm II. Delayed toxicity was comparable in both arms. The 2-year DFS was 67.6 ± 5.9% in the whole group. This was affected significantly by performance status (p = 0.009), pathological stage (p = 0.001), tumor cell type (p = 0.053), nodal involvement (p = 0.07) and number of risk factors (p = 0.09). Though there was improvement of DFS from 61.5 ± 7.4% in PORT group to 70.9 ± 6.1% in chemoradiotherapy group, yet it was not statistically significant (p = 0.2). Patients having one risk factor, low pathological stage or no nodal involvement in arm II experienced better DFS than those in arm I (p = 0.07, 0.08 and 0.09 respectively). Conclusions: Adjuvant chemoradiotherapy using Gemcitabine-cisplatin and PORT was tolerable with minimal severe toxicities. There was DFS improvement with the addition of chemotherapy to PORT (not statistically significant yet). Patients with one risk factor, lower pathological stage or no nodal involvement seemed to benefit more from added chemotherapy. No significant financial relationships to disclose.

PROSPECTIVE RANDOMIZED TRIAL OF OPEN VERSUS ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY FOR BLADDER CANCER: INTERIM RESULTS

2009 ◽  
Vol 181 (4S) ◽  
pp. 377-377 ◽  
Author(s):  
Jeff Nix ◽  
Matthew Coward ◽  
Angela Smith ◽  
Raj Kurpad ◽  
Heather Schultz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Randomized Trial ◽  
Radical Cystectomy ◽  
Prospective Randomized Trial ◽  
Robotic Assisted ◽  
Open Versus

A controlled prospective randomized trial of adjuvant chemoradiotherapy following radical cystectomy in advanced high risk bladder cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5082-5082
Author(s):  
M. S. Zaghloul ◽  
H. M. Khaled ◽  
M. Lotayef ◽  
H. William ◽  
M. Nazmy ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Risk Factor ◽  
High Risk ◽  
Randomized Trial ◽  
Radical Cystectomy ◽  
Distant Metastasis ◽  
Locally Advanced ◽  
Prospective Randomized Trial ◽  
Adjuvant Chemoradiotherapy ◽  
Nodal Involvement

5082 Background: High risk locally advanced bladder cancer patients experienced low survival rates, high local recurrence and high rate of distant metastasis. Postoperative radiotherapy (PORT) improved local control and survival, yet it did not affect distant metastasis. Methods: A prospective randomized trial was performed at NCI, Cairo, Egypt including 146 patients in 2 arms. Patients who underwent radical cystectomy and pelvic lymphadenectomy had to have one or more of the following: stage P3b or P4a, G3 or involved lymphadenopathy. Arm I (74 patients) received PORT 45 Gy/30 fractions/3 weeks. Arm II (72 patients) received 2 courses of adjuvant chemotherapy (Gemcitabine 1 gm/m2 D1 and D8 and cisplatin 70 mg/m2 D2), same PORT regimen followed by another 2 courses of Gemcitabine-cisplatin. Results: Chemotherapy and radiation were tolerated with grade 1/2 toxicities. Delayed toxicity was comparable in both arms. The 45-month DFS was 51 ± 12 % in the whole group. This was affected significantly by performance status (p = 0.0001), pathological stage (p = 0.0099), nodal involvement (p = 0.004) and number of risk factors (p = 0.16). Though there was improvement of 45-month DFS from 28 ± 20% in PORT group to 70 ± 6 % in chemoradiotherapy group, yet it did not reach to the level of statistical significance (p = 0.18). Patients having one risk factor, G3 or no nodal involvement in arm II experienced better DFS than those in arm I (p = 0.17, 0.11 and 0.17 respectively). Distant metastasis-free survival (DMF) rate increased with the addition of chemotherapy from 29±21% to 75±6%. This effect was intensified in patients having one risk factor, grade 3 and negative nodes. Conclusions: Adjuvant chemoradiotherapy using Gemcitabine-cisplatin and PORT was tolerable. There was DFS improvement and higher DMF rates with the addition of chemotherapy to PORT (not statistically significant yet). Patients with one risk factor, G3 or no nodal involvement seemed to benefit more from the added chemotherapy. No significant financial relationships to disclose.

scholarly journals Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016

2018 ◽  
Vol 6 (9) ◽  
pp. 1647-1651 ◽  
Author(s):  
Yudiana Wayan ◽  
Pratiwi Dinar Ayu ◽  
Oka A. A. Gde ◽  
Niryana Wayan ◽  
I Putu Eka Widyadharma
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Wound Dehiscence ◽  
Oncological Outcome ◽  
Pathological Result ◽  
Muscle Invasive

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.

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