Moderated Poster
Cosimo De Nunzio
Department of Urology, Ospedale Sant'andrea, Sapienza University
Presentation Authors: Laura Izquierdo, Barcelona, Spain, Riccardo Lombardo, Giorgia Tema, Fabiana Cancrini, Rome, Italy, Giuseppe Lotrecchiano, Benevento, Italy, Andrea Minervini, Florence, Italy, Giuseppe Simone, Rome, Italy, Luca Cindolo, Carlo D'orta, Vasto, Italy, Tarek Ajami, Barcelona, Spain, Alessandro Antonelli, Brescia, Italy, Daniele Castellani, Ancona, Italy, Antonio Alcaraz, Barcelona, Spain, Andrea Tubaro, Cosimo De Nunzio*, Rome, Italy
Introduction: Elderly and frail patients are becoming more common in our clinical practice. Currently one of the greatest challenges is balancing the life expectancy of those patients against aggressive treatments that carry significant risks. The aim of our study was to describe complication rates up to 30 days of patients with radical cystectomy with cutaneous ureterostomy diversion (CUD).
Methods: The study included a large International multicenter cohort (10 centers) of 365 patients undergoing radical cystectomy with CUD for bladder cancer between 2011 and 2017. Demographic, clinical and histological characteristics of all patients were recorded. Indications for CUD were advanced age, single kidney, comorbities and history of multiple bowel surgeries. Perioperative (up to 30 days) complications were recorded according the Clavien Classification System (CCS). High grade complications were defined as CCS ≥ IIIa.
Results: Median (range) age was 76 (47/89) years. Overall, males were 295/365 (81%) and females 70/365 (19%). The ASA score was: I in 9/365 (2%); II in 102/365 (28%), III in 209/365 (58%) and IV in 42/365 (12%) patients. Median (range) operative time and hospitalization stay were 210 (60/500) min and 14 (2/119) days, respectively. Overall 58 (15%) underwent monolateral ureterostomy and 307 (85%) underwent bilateral ureterostomy. Advance disease(pT≥3a) was present in 233 (64%) and positive nodes in 91 (25%) patients. Overall morbidity and mortality rates were 67% and 2% respectively. Low-grade complications’ (CCS ≤II) rate of the series was 80%, anemia requiring transfusion being the most common one (Table I). High grade complications ‘rate was 12% and out of them only 14 cases (34%) required surgical intervention under general anesthesia or advanced life support (CCS ≥IIIb)
Conclusions: Cutaneous ureterostomy diversion in patients undergoing radical cystectomy for bladder cancer is a valid surgical option with a high grade Clavien complication rate of 12%. Cutaneous ureterostomy diversion should be considered in patients with aggressive disease and/or poor performance status.