UP-33 The University of Alberta Experience with Radical Cystectomy via Minimally Invasive Approaches
Thursday June 27, 2019 from
TBD
Presenter

Alexander R Hengel, Canada

Medical student

UBC faculty of Medicine

Abstract

The University of Alberta experience with radical cystectomy via minimally invasive approaches

Alexander Hengel1, Jan K. Rudzinski1,2, Benjamin Beech1, Natasha P Govindasamy2, Eric Estey1, Howard J. Evans1, Blair A. St Martin1.

1Division of Urology, University of Alberta, Edmonton, AB, Canada; 2Department of Oncology, University of Alberta, Edmonton, AB, Canada

Introduction: Radical cystectomy is the standard of care treatment for muscle invasive bladder cancer. It is associated with high morbidity and significant risk of peri- and post-operative complications. Minimally invasive (MI) approaches seek to lessen the morbidity without sacrificing oncologic outcomes. Due to limited resources and the technical challenges involved, MI radical cystectomy (MIRC) has had limited uptake in Canada. Herein we present, to our knowledge, the largest case series of MIRC in a Canadian setting.

Methods: A retrospective review was performed. We identified all patients undergoing MIRC for bladder cancer at our centre from 2006-2020. We collected data on demographics, oncologic staging, peri- and post-operative outcomes, length of stay (LOS), perioperative blood transfusions, uretero-ileal anastomotic stricture occurrence, recurrence free survival, and overall survival (OS). Descriptive statistics and Kaplan-Meir survival analysis were used to assess outcomes.

Results: Overall, 29 patients underwent MIRC, 10 using a laparoscopic approach and 19 using robotic assisted laparoscopic approach. Median age at time of MIRC was 66.5 years. Ileal conduit urinary diversion was performed in 23/29, neobladder in 5/29, and 1 patient was left without urinary diversion (hemodialysis). Median LOS was 8 days (range 3-89 days). Three patients received blood transfusions within 90 days of MIRC. Uretero-ileal anastomotic stricture occurred in 6/28 (21.4%). In total, 7 patients had recurrence of their cancer with the median time to recurrence of 9.8 months (range 4.6mo -4.9yrs). Predicted 5-year OS of the group was 57.3% (CI: 37.2-73.1%).

Conclusion: We present the University of Alberta experience with MIRC for bladder cancer. Outcomes were modest and may reflect the learning curve of these technically challenging procedures. Further study is required to elucidate the role MI versus open approach to radical cystectomy, especially in the resource limited Canadian setting.


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