Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions

Dipen J Parekh, Travis Clark, Jeffrey O'Connor, Charlie Jung, Sam S. Chang, Michael Cookson, Joseph A. Smith

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Purpose: A significant number of patients requiring radical cystectomy for bladder cancer have substantial co-morbidity. Nonetheless, these patients often prefer orthotopic neobladder reconstruction to avoid an abdominal stoma. We performed a retrospective study to determine perioperative morbidity in this group of patients. Materials and Methods: We used the American Society of Anesthesiologists physical status classification to assign perioperative risk. Of 250 patients undergoing orthotopic neobladder reconstruction after radical cystectomy during a 5-year period we identified 84 with an American Society of Anesthesiologists score of 3 or greater. Charts were available for review for all patients and none was lost to followup. Results: Median operative time (calculated from anesthesia ready time to completion of surgery and application of a dressing) was 256 minutes. In 14 patients (16.6%) transfusion of a median of 2 units of allogeneic blood was required. A total of 79 patients (94$) were transferred directly from the recovery ronm to the general urology floor without a need for postoperative cardiac monitoring. Ledian hospital stay was 7 days. One patient (1.1%) died on postopera-tive day 9 of a presumed pulmonary embolus after having been discharged home on postoperative day 6. Minor complications occurred in 16 patients (19%). Only 1 patient required a return to the operating room for endoscopic removal of a retained stent fragment. Conclusions: In experienced hands radical cystectomy and orthotopic neobladder can be offered to patients with co-morbid conditions. Expeditious performance of the surgical procedure, minimization of blood loss, restricting the surgical incision to an infraumbilical location, and avoidance of intraoperative complications all contribute to decreasing morbidity and mortality. Although orthotopic reconstruction is more complex than performance of an ileal conduit, there is no apparent increase in perioperative morbidity or mortality. Therefore, orthotopic reconstruction can be offered to patients who want to avoid an abdominal stoma even in the face of significant co-morbid conditions.

Original languageEnglish
Pages (from-to)2454-2456
Number of pages3
JournalJournal of Urology
Volume168
Issue number6
StatePublished - Dec 1 2002
Externally publishedYes

Fingerprint

Cystectomy
Morbidity
Urinary Diversion
Mortality
Intraoperative Complications
Urology
Operating Rooms
Bandages
Operative Time
Embolism
Urinary Bladder Neoplasms
Stents
Length of Stay
Anesthesia
Retrospective Studies

Keywords

  • Bladder neoplasms
  • Comorbidity
  • Cystectomy

ASJC Scopus subject areas

  • Urology

Cite this

Parekh, D. J., Clark, T., O'Connor, J., Jung, C., Chang, S. S., Cookson, M., & Smith, J. A. (2002). Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions. Journal of Urology, 168(6), 2454-2456.

Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions. / Parekh, Dipen J; Clark, Travis; O'Connor, Jeffrey; Jung, Charlie; Chang, Sam S.; Cookson, Michael; Smith, Joseph A.

In: Journal of Urology, Vol. 168, No. 6, 01.12.2002, p. 2454-2456.

Research output: Contribution to journalArticle

Parekh, DJ, Clark, T, O'Connor, J, Jung, C, Chang, SS, Cookson, M & Smith, JA 2002, 'Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions', Journal of Urology, vol. 168, no. 6, pp. 2454-2456.
Parekh, Dipen J ; Clark, Travis ; O'Connor, Jeffrey ; Jung, Charlie ; Chang, Sam S. ; Cookson, Michael ; Smith, Joseph A. / Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions. In: Journal of Urology. 2002 ; Vol. 168, No. 6. pp. 2454-2456.
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abstract = "Purpose: A significant number of patients requiring radical cystectomy for bladder cancer have substantial co-morbidity. Nonetheless, these patients often prefer orthotopic neobladder reconstruction to avoid an abdominal stoma. We performed a retrospective study to determine perioperative morbidity in this group of patients. Materials and Methods: We used the American Society of Anesthesiologists physical status classification to assign perioperative risk. Of 250 patients undergoing orthotopic neobladder reconstruction after radical cystectomy during a 5-year period we identified 84 with an American Society of Anesthesiologists score of 3 or greater. Charts were available for review for all patients and none was lost to followup. Results: Median operative time (calculated from anesthesia ready time to completion of surgery and application of a dressing) was 256 minutes. In 14 patients (16.6{\%}) transfusion of a median of 2 units of allogeneic blood was required. A total of 79 patients (94$) were transferred directly from the recovery ronm to the general urology floor without a need for postoperative cardiac monitoring. Ledian hospital stay was 7 days. One patient (1.1{\%}) died on postopera-tive day 9 of a presumed pulmonary embolus after having been discharged home on postoperative day 6. Minor complications occurred in 16 patients (19{\%}). Only 1 patient required a return to the operating room for endoscopic removal of a retained stent fragment. Conclusions: In experienced hands radical cystectomy and orthotopic neobladder can be offered to patients with co-morbid conditions. Expeditious performance of the surgical procedure, minimization of blood loss, restricting the surgical incision to an infraumbilical location, and avoidance of intraoperative complications all contribute to decreasing morbidity and mortality. Although orthotopic reconstruction is more complex than performance of an ileal conduit, there is no apparent increase in perioperative morbidity or mortality. Therefore, orthotopic reconstruction can be offered to patients who want to avoid an abdominal stoma even in the face of significant co-morbid conditions.",
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AU - Cookson, Michael

AU - Smith, Joseph A.

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N2 - Purpose: A significant number of patients requiring radical cystectomy for bladder cancer have substantial co-morbidity. Nonetheless, these patients often prefer orthotopic neobladder reconstruction to avoid an abdominal stoma. We performed a retrospective study to determine perioperative morbidity in this group of patients. Materials and Methods: We used the American Society of Anesthesiologists physical status classification to assign perioperative risk. Of 250 patients undergoing orthotopic neobladder reconstruction after radical cystectomy during a 5-year period we identified 84 with an American Society of Anesthesiologists score of 3 or greater. Charts were available for review for all patients and none was lost to followup. Results: Median operative time (calculated from anesthesia ready time to completion of surgery and application of a dressing) was 256 minutes. In 14 patients (16.6%) transfusion of a median of 2 units of allogeneic blood was required. A total of 79 patients (94$) were transferred directly from the recovery ronm to the general urology floor without a need for postoperative cardiac monitoring. Ledian hospital stay was 7 days. One patient (1.1%) died on postopera-tive day 9 of a presumed pulmonary embolus after having been discharged home on postoperative day 6. Minor complications occurred in 16 patients (19%). Only 1 patient required a return to the operating room for endoscopic removal of a retained stent fragment. Conclusions: In experienced hands radical cystectomy and orthotopic neobladder can be offered to patients with co-morbid conditions. Expeditious performance of the surgical procedure, minimization of blood loss, restricting the surgical incision to an infraumbilical location, and avoidance of intraoperative complications all contribute to decreasing morbidity and mortality. Although orthotopic reconstruction is more complex than performance of an ileal conduit, there is no apparent increase in perioperative morbidity or mortality. Therefore, orthotopic reconstruction can be offered to patients who want to avoid an abdominal stoma even in the face of significant co-morbid conditions.

AB - Purpose: A significant number of patients requiring radical cystectomy for bladder cancer have substantial co-morbidity. Nonetheless, these patients often prefer orthotopic neobladder reconstruction to avoid an abdominal stoma. We performed a retrospective study to determine perioperative morbidity in this group of patients. Materials and Methods: We used the American Society of Anesthesiologists physical status classification to assign perioperative risk. Of 250 patients undergoing orthotopic neobladder reconstruction after radical cystectomy during a 5-year period we identified 84 with an American Society of Anesthesiologists score of 3 or greater. Charts were available for review for all patients and none was lost to followup. Results: Median operative time (calculated from anesthesia ready time to completion of surgery and application of a dressing) was 256 minutes. In 14 patients (16.6%) transfusion of a median of 2 units of allogeneic blood was required. A total of 79 patients (94$) were transferred directly from the recovery ronm to the general urology floor without a need for postoperative cardiac monitoring. Ledian hospital stay was 7 days. One patient (1.1%) died on postopera-tive day 9 of a presumed pulmonary embolus after having been discharged home on postoperative day 6. Minor complications occurred in 16 patients (19%). Only 1 patient required a return to the operating room for endoscopic removal of a retained stent fragment. Conclusions: In experienced hands radical cystectomy and orthotopic neobladder can be offered to patients with co-morbid conditions. Expeditious performance of the surgical procedure, minimization of blood loss, restricting the surgical incision to an infraumbilical location, and avoidance of intraoperative complications all contribute to decreasing morbidity and mortality. Although orthotopic reconstruction is more complex than performance of an ileal conduit, there is no apparent increase in perioperative morbidity or mortality. Therefore, orthotopic reconstruction can be offered to patients who want to avoid an abdominal stoma even in the face of significant co-morbid conditions.

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KW - Comorbidity

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