Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy.
Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy.
Surg Oncol. 2023 Oct;50:101973. doi: 10.1016/j.suronc.2023.101973. Epub 2023 Jul 11.
Previous radical prostatectomy (RP) for prostate cancer (PCa) might impair feasibility of radical cystectomy (RC) for bladder cancer (BCa). The current study addressed morbidity, operative time (OT), and length of stay (LOS) of RC, within the largest available series of patients with history of previous RP.
All patients previously submitted to RP for PCa and subsequently submitted to RC for BCa, at six high-volume European institutions between 2010 and 2019, were identified. Presence of either PCa or BCa metastases, RT as primary treatment for PCa, and palliative RC represented exclusion criteria. The quality criteria for accurate and comprehensive reporting of intra- and post-operative surgical outcomes, recommended by the European Association of Urology guidelines, were fulfilled. Multivariable logistic and Poisson regression analyses were performed.
Overall, 140 RC patients with history of RP were identified. After RP, 69 (49%) patients received radiotherapy (RT) for PCa, either in adjuvant (n = 50, 36%) or salvage setting (n = 19, 13%). Median age-adjusted Charlson comorbidity index was 6 (IQR 5, 7). Median OT, estimated blood loss and LOS were, respectively, 300 min, 500 ml, and 16 days. Intra-operative transfusions rate was 47% (n = 65). One intra-operative complication occurred (EAUiaiC grade 2, perforation of the rectum managed with immediate repair). Eighty-two (59%) patients experienced a total of 107 post-operative complications during the hospital stay, and seven (5%) patients required hospital readmission. In multivariable regression analyses, RT for PCa was associated with higher risk of post-operative complications (odds ratio 1.82, p = 0.039), longer OT (incidence rate ratio 1.09, p < 0.001), and longer LOS (incidence rate ratio 1.24, p < 0.001).
RC in patients with history of RP is feasible, albeit burdened by remarkable morbidity, even in centers of excellence. RT after RP for PCa portends worse surgical outcomes.
先前的根治性前列腺切除术（RP）治疗前列腺癌（PCa）可能会影响膀胱癌（BCa）根治性膀胱切除术（RC）的可行性。本研究在最大的一组既往接受过 RP 治疗 PCa 并随后接受 RC 治疗 BCa 的患者系列中，探讨了 RC 的发病率、手术时间（OT）和住院时间（LOS）。
在 2010 年至 2019 年期间，在六个欧洲高容量机构中，确定了所有先前因 PCa 接受 RP 治疗且随后因 BCa 接受 RC 治疗的患者。存在 PCa 或 BCa 转移、RP 作为 PCa 的主要治疗方法以及姑息性 RC 为排除标准。满足欧洲泌尿外科学会指南推荐的准确和全面报告围手术期手术结果的质量标准。进行了多变量逻辑和泊松回归分析。
总体而言，确定了 140 例有 RP 病史的 RC 患者。在 RP 之后，69 例（49%）患者因 PCa 接受了放疗（RT），包括辅助治疗（n=50，36%）或挽救性治疗（n=19，13%）。校正年龄的Charlson 合并症指数中位数为 6（IQR 5，7）。中位 OT、估计失血量和 LOS 分别为 300 分钟、500 毫升和 16 天。术中输血率为 47%（n=65）。发生 1 例术中并发症（EAUiaiC 分级 2，直肠穿孔行即刻修补）。82 例（59%）患者在住院期间共发生 107 例术后并发症，7 例（5%）患者需要再次住院治疗。在多变量回归分析中，PCa 的 RT 与术后并发症的风险增加相关（优势比 1.82，p=0.039）、OT 延长（发病率比 1.09，p<0.001）和 LOS 延长（发病率比 1.24，p<0.001）。
尽管在卓越中心，RP 后行 RC 治疗的患者并发症发生率显著，但 RC 仍然可行。RP 后行 RT 治疗 PCa 预示着更差的手术结果。
