Do perioperative blood transfusions impact oncological outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion? Results from a large multi-institutional registry.

Humans Cystectomy / adverse effects Urinary Bladder / surgery Carcinoma, Transitional Cell / surgery Urinary Bladder Neoplasms / pathology Robotics Treatment Outcome Robotic Surgical Procedures / adverse effects Urinary Diversion / adverse effects

Journal

Minerva urology and nephrology
ISSN: 2724-6442
Titre abrégé: Minerva Urol Nephrol
Pays: Italy
ID NLM: 101777299

Informations de publication

Date de publication:
Feb 2023
Historique:
entrez: 20 2 2023
pubmed: 21 2 2023
medline: 22 2 2023
Statut: ppublish

Résumé

Blood transfusions (BT) have been associated with adverse oncologic outcomes in multiple malignancies including open radical cystectomy (ORC) for urothelial carcinoma of the bladder (UCB). Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) delivers similar oncologic outcomes compared to ORC, yet with lower blood loss and reduced transfusions. However, the impact of BT after robotic cystectomy is still unknown. This is a multicenter study including patients treated for UCB with RARC and ICUD in 15 academic institutions, between January 2015 and January 2022. BT were administered during surgery (intraoperative blood transfusions, iBT) or during the first 30 days after surgery (post-operative blood transfusions, pBT). The association of iBT and pBT with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated by univariate and multivariate regression analysis. A total of 635 patients were included in the study. Overall, 35/635 patients (5.51%) received iBT while 70/635 (11.0%) received pBT. After a mean follow-up of 23±18 months, 116 patients (18.3%) had died, including 96 (15.1%) from bladder cancer. Recurrence occurred in 146 patients (23%). iBT were associated with decreased RFS, CSS and OS (P<0.001) on univariate Cox analysis. After adjusting for clinicopathologic covariates, iBT were associated only with the risk of recurrence (HR: 1.7; 95% CI, 1.0-2.8, P=0.04). pBT were not significantly associated to RFS, CSS or OS on univariate and multivariate Cox regression models (P>0.05). In the present study, patients treated by RARC with ICUD for UCB have a higher risk of recurrence after iBT, yet no significant association with CSS and OS was found. pBT are not associated with worse oncological prognosis.

Sections du résumé

BACKGROUND BACKGROUND
Blood transfusions (BT) have been associated with adverse oncologic outcomes in multiple malignancies including open radical cystectomy (ORC) for urothelial carcinoma of the bladder (UCB). Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) delivers similar oncologic outcomes compared to ORC, yet with lower blood loss and reduced transfusions. However, the impact of BT after robotic cystectomy is still unknown.
METHODS METHODS
This is a multicenter study including patients treated for UCB with RARC and ICUD in 15 academic institutions, between January 2015 and January 2022. BT were administered during surgery (intraoperative blood transfusions, iBT) or during the first 30 days after surgery (post-operative blood transfusions, pBT). The association of iBT and pBT with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated by univariate and multivariate regression analysis.
RESULTS RESULTS
A total of 635 patients were included in the study. Overall, 35/635 patients (5.51%) received iBT while 70/635 (11.0%) received pBT. After a mean follow-up of 23±18 months, 116 patients (18.3%) had died, including 96 (15.1%) from bladder cancer. Recurrence occurred in 146 patients (23%). iBT were associated with decreased RFS, CSS and OS (P<0.001) on univariate Cox analysis. After adjusting for clinicopathologic covariates, iBT were associated only with the risk of recurrence (HR: 1.7; 95% CI, 1.0-2.8, P=0.04). pBT were not significantly associated to RFS, CSS or OS on univariate and multivariate Cox regression models (P>0.05).
CONCLUSIONS CONCLUSIONS
In the present study, patients treated by RARC with ICUD for UCB have a higher risk of recurrence after iBT, yet no significant association with CSS and OS was found. pBT are not associated with worse oncological prognosis.

Identifiants

DOI: 10.23736/S2724-6051.22.05109-6 PMID: 36800680
pubmed: 36800680
pii: S2724-6051.22.05109-6
doi: 10.23736/S2724-6051.22.05109-6
doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

50-58

Commentaires et corrections

Type : CommentIn

Auteurs

Julien Sarkis (J)

Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium - Juliensarkis@live.com.

Romain Diamand (R)

Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.

Fouad Aoun (F)

Department of Urology, Hotel Dieu de France, Beirut, Lebanon.

Gregoire Assenmacher (G)

Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium.

Christophe Assenmacher (C)

Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium.

Gregory Verhoest (G)

Department of Urology, CHU Rennes, Rennes, France.

Serge Holz (S)

Department of Urology, CHU Ambroise Paré, Mons, Belgium.

Michel Naudin (M)

Department of Urology, CHU Ambroise Paré, Mons, Belgium.

Guillaume Ploussard (G)

Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France.
Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France.

Andrea Mari (A)

Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy.

Andrea Minervini (A)

Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy.

Andrea Tay (A)

Department of Urology, Saint Georges Hospital, London, UK.

Rami Issa (R)

Department of Urology, Saint Georges Hospital, London, UK.

Mathieu Roumiguié (M)

Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France.

Anne S Bajeot (AS)

Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France.

Giuseppe Simone (G)

Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

Umberto Anceschi (U)

Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

Paolo Umari (P)

Division of Surgery and Interventional Sciences, University College of London, London, UK.

Ashwin Sridhar (A)

Division of Surgery and Interventional Sciences, University College of London, London, UK.

John Kelly (J)

Division of Surgery and Interventional Sciences, University College of London, London, UK.

Kees Hendricksen (K)

Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands.

Sarah Einerhand (S)

Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands.

Laura S Mertens (LS)

Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands.

Rafael Sanchez-Salas (R)

Department of Urology, Montsouris Mutualiste Institute, Paris, France.

Anna Colomer (A)

Department of Urology, Montsouris Mutualiste Institute, Paris, France.

Thierry Quackels (T)

Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.

Alexandre Peltier (A)

Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.

Francesco Montorsi (F)

Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Alberto Briganti (A)

Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Benjamin Pradere (B)

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology UROSUD, Croix Du Sud Hospital, Quint-Fonsegrives, France.

Marco Moschini (M)

Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Thierry Roumeguère (T)

Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.
Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.

Simone Albisinni (S)

Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.
Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Do perioperative blood transfusions impact...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Cystectomie › Do perioperative blood transfusions impact...
questionsmedicales.fr › Appareil urogénital › Voies urinaires › Vessie urinaire › Do perioperative blood transfusions impact...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Carcinomes › Carcinome transitionnel › Do perioperative blood transfusions impact...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs de la vessie urinaire › Do perioperative blood transfusions impact...
questionsmedicales.fr › Sciences de l'information › Méthodologies informatiques › Algorithmes › Intelligence artificielle › Robotique › Do perioperative blood transfusions impact...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Do perioperative blood transfusions impact...
questionsmedicales.fr › Technologie, industrie et agriculture › Technologie › Automatisation › Interventions chirurgicales robotisées › Do perioperative blood transfusions impact...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Dérivation urinaire › Do perioperative blood transfusions impact...