Single staff cystectomy in a low-volume center: Oncological outcomes and complications

Authors

  • Philipp Baumeister Luzerner Kantonsspital
  • Davide Galioto Luzerner Kantonsspital
  • Marco Moschini Luzerner Kantonsspital
  • Chiara Lonati Luzerner Kantonsspital
  • Stefania Zamboni Luzerner Kantonsspital
  • Luca Afferi Luzerner Kantonsspital
  • Patrick Stucki Luzerner Kantonsspital
  • Hansjörg Danuser Luzerner Kantonsspital
  • Dirk Lehnick Luzerner Kantonsspital
  • Livio Mordasini Luzerner Kantonsspital
  • Agostino Mattei Luzerner Kantonsspital

DOI:

https://doi.org/10.5489/cuaj.7171

Keywords:

bladder cancer; radical cystectomy; complications; lymph node dissection; urothelial cancer; extended lymph node dissection

Abstract

Introduction: Radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) is a complex surgical procedure, associated with substantial perioperative complications. Previous studies suggested reserving it to high-volume centers in order to improve oncological and perioperative outcomes. However, only limited data exist regarding low-volume centers with highly experienced surgeons. We aimed to assess oncological and perioperative outcomes after RC performed by experienced surgeons in the low-volume center of Luzerner Kantonsspital, Lucerne, CH.

Methods: We retrospectively analyzed data of 158 patients who underwent RC and PLND performed between 2009 and 2019 at a single low-volume center by three experienced surgeons, each having performed at least 50 RCs. Complications were graded according to the 2004 modified Clavien-Dindo grading system.

Results: A total of 110 patients (70%) received an incontinent urinary diversion (ileal conduit or ureterocutaneostomy) and 48 patients (30%) received a continent urinary diversion (ileal orthotopic neobladder, ureterosigmoidostomy, or Mitrofanoff pouch). Median operating time was 419 minutes (interquartile range [IQR] 346–461). Overall, at RC specimen, 71.5% of patients had urothelial carcinoma ,12.6% squamous, 3.1% sarcomatoid, 1.2%glandular, and 0.6% small cell carcinoma. Median number of lymph nodes removed was 23 (IQR 16–29.5). Positive margins were found in eight patients (5.1%). Overall, five-year survival rate was 52.4%. The complication rate was 56.3%: 143 complications were found in 89 patients, 36 (22.8%) with Clavien ≥3. The 30-day mortality rate was 2.5%.

Conclusions: RC could be safely performed in a low-volume center by experienced surgeons with comparable outcomes to high-volume centers.

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Author Biographies

Davide Galioto, Luzerner Kantonsspital

Department of Urology

Marco Moschini, Luzerner Kantonsspital

Department of Urology

Chiara Lonati, Luzerner Kantonsspital

Department of Urology

Stefania Zamboni, Luzerner Kantonsspital

Department of Urology

Luca Afferi, Luzerner Kantonsspital

Department of Urology

Patrick Stucki, Luzerner Kantonsspital

Department of Urology

Hansjörg Danuser, Luzerner Kantonsspital

Department of urology

Dirk Lehnick, Luzerner Kantonsspital

Department of Biostatistics

Livio Mordasini, Luzerner Kantonsspital

Department of urology

Agostino Mattei, Luzerner Kantonsspital

Department of Urology

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Published

2021-05-11

How to Cite

Baumeister, P., Galioto, D., Moschini, M., Lonati, C., Zamboni, S., Afferi, L., Stucki, P., Danuser, H., Lehnick, D., Mordasini, L., & Mattei, A. (2021). Single staff cystectomy in a low-volume center: Oncological outcomes and complications. Canadian Urological Association Journal, 15(11). https://doi.org/10.5489/cuaj.7171

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Section

Original Research