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James W.f. Catto - One of the best experts on this subject based on the ideXlab platform.
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Comparing open-radical Cystectomy and robot-assisted radical Cystectomy: current status and analysis of the evidence.
Current opinion in urology, 2020Co-Authors: Pramit Khetrapal, John D. Kelly, Samantha Conroy, James W.f. CattoAbstract:PURPOSE OF REVIEW Radical Cystectomy is the definitive surgical treatment for aggressive bladder cancer. The robotic platform offers a new approach to radical Cystectomy, but the benefits are unclear. This review examines the latest evidence, with a particular focus on developments in the last two years. RECENT FINDINGS Prospective evaluations of open (ORC) and robot-assisted radical Cystectomy (RARC) are emerging. The radical Cystectomy in patients with bladder cancer trial reported in 2018 and demonstrated oncological noninferiority for both approaches and marginal shorter length of stays with RARC using an extracorporeal reconstruction. The trial confirmed prospective randomized comparisons are possible, and replicates observations from two earlier, smaller randomised controlled trials with longer follow-up. Although there has been significant traction to the intracorporeal approach to RARC, randomized trial evidence is awaited to show any benefit over ORC. SUMMARY New evidence alludes to the noninferiority of the robotic platform in radical Cystectomy in comparison to open surgery. There is minimal evidence of a clinically meaningful benefit. Until this is addressed, ORC remains the gold standard for the definitive surgical management of bladder cancer.
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multidomain quantitative recovery following radical Cystectomy for patients within the robot assisted radical Cystectomy with intracorporeal urinary diversion versus open radical Cystectomy randomised controlled trial the first 30 patients
European Urology, 2018Co-Authors: James W.f. Catto, Pramit Khetrapal, Gareth Ambler, Rachael Sarpong, Ingrid Potyka, Shamim Khan, Melanie Tan, Andrew Feber, Liam BourkeAbstract:Many patients develop complications after radical Cystectomy (RC) [1]. Reductions in morbidity have occurred through centralisation and technical improvements [2], and perhaps through robot-assisted RC (RARC). Whilst RARC is gaining popularity, there are concerns about oncological safety [3] and extracorporeal reconstruction [4], and randomised controlled trials (RCTs) find little difference [5]. We are conducting a prospective RCT comparing open RC and RARC with mandated intracorporeal reconstruction (Robot-assisted Radical Cystectomy with intracorporeal urinary diversion versus Open Radical Cystectomy [iROC] trial) [6].
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The Road to Cystectomy: Who, When and Why?
EAU Update Series, 2005Co-Authors: James W.f. Catto, Derek J RosarioAbstract:Abstract Objectives: Bladder cancer is the fifth most common solid malignancy amongst men in the western world. Around 30% of newly diagnosed patients will eventually die from the disease. Radical treatment with curative intent is the best option for patients with invasive bladder cancer. Cystectomy and urinary diversion represents a time-tested robust approach to treating this disease. Here we review the current indications for Cystectomy and staging methods for transitional cell carcinoma (TCC). Methods: We conducted a search of the current literature to evaluate the evidence for the indications for Cystectomy and the staging of TCC of the urinary bladder. Results: Radical Cystectomy is usually performed for either invasive or high risk superficial bladder cancer. The outcome is dependent on the pathological stage of tumour at Cystectomy. Whilst novel molecular staging methods are in development, current staging is by clinical, pathological and radiological methods. There is a recognised risk of either over- or under- staging the disease using current imaging techniques. Conclusion: The indications for radical Cystectomy are changing with more emphasis on surgery for high-risk superficial disease. Better stratification of superficial disease has allowed the identification of such high risk cancers. It is likely that advances in molecular diagnosis and staging will come through to clinical practice in the near future.
Ahmed A. Hussein - One of the best experts on this subject based on the ideXlab platform.
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Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
The Journal of urology, 2019Co-Authors: Ahmed A. Hussein, Ahmed Elsayed, Naif A. Aldhaam, Zhe Jing, Jennifer Osei, Jihad H. Kaouk, Juan Palou Redorta, Mani Menon, James O. Peabody, Prokar DasguptaAbstract:Purpose:Radical Cystectomy is the gold standard for nonmetastatic muscle invasive bladder cancer and for refractory nonmuscle invasive disease. Compared to open radical Cystectomy, robot-assisted r...
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reoperations following robot assisted radical Cystectomy a decade of experience
The Journal of Urology, 2016Co-Authors: Zishan Hashmi, Seyedeh Dibaj, Tareq Altartir, Thomas Fiorica, Joseph Wing, Mohammad Durrani, John Binkowski, Ahmed A. Hussein, Lesley BoatengAbstract:Purpose: There is a paucity of data regarding the operative management of complications after robot-assisted radical Cystectomy. We reviewed operative management of robot-assisted radical Cystectomy specific complications during our 10-year experience with this procedure and assessed the feasibility, safety and outcomes of robot-assisted reoperations.Materials and Methods: We retrospectively reviewed the records of all patients who underwent surgical interventions for robot-assisted radical Cystectomy specific complications between 2005 and 2015. Univariable and multivariable logistic regression models were fit to evaluate predictors of surgical intervention after robot-assisted radical Cystectomy. Kaplan-Meier curves were used to describe time to surgical interventions.Results: A total of 92 patients (23%) underwent surgical intervention after robot-assisted radical Cystectomy. Mean followup was 27 months. Average time to any surgical intervention after Cystectomy was 14 months. The reoperation rate was ...
Prokar Dasgupta - One of the best experts on this subject based on the ideXlab platform.
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Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
The Journal of urology, 2019Co-Authors: Ahmed A. Hussein, Ahmed Elsayed, Naif A. Aldhaam, Zhe Jing, Jennifer Osei, Jihad H. Kaouk, Juan Palou Redorta, Mani Menon, James O. Peabody, Prokar DasguptaAbstract:Purpose:Radical Cystectomy is the gold standard for nonmetastatic muscle invasive bladder cancer and for refractory nonmuscle invasive disease. Compared to open radical Cystectomy, robot-assisted r...
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a single centre early phase randomised controlled three arm trial of open robotic and laparoscopic radical Cystectomy coral
European Urology, 2016Co-Authors: Muhammad Shamim Khan, Christine Gan, Kamran Ahmed, Ahmad Fahim Ismail, Jane Watkins, Jennifer Summers, Janet L Peacock, Peter Rimington, Prokar DasguptaAbstract:Background: Laparoscopic radical Cystectomy (LRC) and robot-assisted radical Cystectomy (RARC) are increasingly popular, but high-level evidence for these techniques remains lacking. Objective: To compare the outcomes of patients undergoing open radical Cystectomy (ORC), RARC, and LRC.
Michele Gallucci - One of the best experts on this subject based on the ideXlab platform.
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perioperative and mid term oncologic outcomes of robotic assisted radical Cystectomy with totally intracorporeal neobladder results of a propensity score matched comparison with open cohort from a single centre series
Ejso, 2018Co-Authors: Giuseppe Simone, Mariaconsiglia Ferriero, Salvatore Guaglianone, Gabriele Tuderti, Leonardo Misuraca, Umberto Anceschi, F Minisola, Michele GallucciAbstract:Abstract Aim In this study, we compared perioperative and oncologic outcomes of patients treated with either open or robot-assisted radical Cystectomy and intracorporeal neobladder at a tertiary care center. Methods The institutional prospective bladder cancer database was queried for “Cystectomy with curative intent” and “neobladder”. All patients underwent robot-assisted radical Cystectomy and intracorporeal neobladder or open radical Cystectomy and orthotopic neobladder for high-grade non-muscle invasive bladder cancer or muscle invasive bladder cancer with a follow-up length ≥2 years were included. A 1:1 propensity score matching analysis was used. Kaplan-Meier method was performed to compare oncologic outcomes of selected cohorts. Survival rates were computed at 1,2,3 and 4 years after surgery and the log rank test was applied to assess statistical significance between the matched groups. Results Overall, 363 patients (299 open and 64 robotic) were included. Open radical Cystectomy patients were more frequently male (p = 0.08), with higher pT stages (p = 0.003), lower incidence of urothelial histologies (p = 0.05) and lesser adoption of neoadjuvant chemotherapy ( Conclusions Robot-assisted radical Cystectomy and intracorporeal neobladder provides comparable oncologic outcomes of open radical Cystectomy and orthotopic neobladder at intermediate term survival analysis.
Kenneth S. Koeneman - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic Radical Cystectomy and Urinary Diversion with Handport Assistance
Essential Urologic Laparoscopy, 2010Co-Authors: Marklyn Jones, J. Kyle Anderson, Kenneth S. KoenemanAbstract:Radical Cystectomy is the standard of care for muscle invasive bladder cancer in the United States. Since the first reported simple laparoscopic Cystectomy in 1992, multiple authors have reported on the use of laparoscopy for radical Cystectomy (1). Gill et al. reported the first two cases of laparoscopic radical cystoprostatectomy with ileal conduit done completely intracorporeally in 2000 (2). A case report documented the use of the hand-assisted laparoscopic (HAL) technique for radical Cystectomy with ileal conduit construction extracorpeally through the hand port for the first time (3). Since the first reported HAL Cystectomy, two series reports for HAL Cystectomy included seven and eight patients (4,5). Taylor et al. demonstrated in a prospective, non-randomized comparison that HAL Cystectomy resulted in less blood loss (637 vs. 957 cc, p=0.23), decreased postoperative pain (31 vs. 149 mg morphine, p=0.01), shorter hospital stays (6.4 vs. 9.8 days, p=0.06) and decreased time to resumption of a regular diet (4.5 vs. 7.9 days, p=0.05) compared to open Cystectomy. The immediate oncologic outcomes appear comparable in most laparoscopic Cystectomy series, but long-term results are not available.
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Hand assisted laparoscopic Cystectomy with minilaparotomy ileal conduit: series report and comparison with open Cystectomy.
The Journal of Urology, 2004Co-Authors: Grant D. Taylor, David A. Duchene, Kenneth S. KoenemanAbstract:ABSTRACTPurpose: To achieve less patient morbidity our initial experience with hand assisted laparoscopic (HAL) Cystectomy was compared with our results of open Cystectomy with similar urinary diversion.Materials and Methods: During 18 months 36 cystectomies were performed, including 20 with open continent diversion. A prospective, nonrandomized comparison of the remaining 16 consecutive cystectomies with ileal conduit diversion (hand assisted laparoscopic Cystectomy and open Cystectomy in 8 cases each) was performed. Of the 16 cystectomies 13 were performed for muscle invasive bladder cancer. Standard parameters were compared concerning patient operative and postoperative courses using statistical analysis with the 2-tailed t test. A novel surgical technique for completing these HAL procedures is described and compared to standard open Cystectomy and ileal conduit diversion.Results: A total of 16 patients successfully underwent open (8) and HAL (8) Cystectomy with an ileal conduit. Mean estimated blood l...
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Hand assisted laparoscopic Cystectomy with minilaparotomy ileal conduit: series report and comparison with open Cystectomy.
The Journal of urology, 2004Co-Authors: Grant D. Taylor, David A. Duchene, Kenneth S. KoenemanAbstract:To achieve less patient morbidity our initial experience with hand assisted laparoscopic (HAL) Cystectomy was compared with our results of open Cystectomy with similar urinary diversion. During 18 months 36 cystectomies were performed, including 20 with open continent diversion. A prospective, nonrandomized comparison of the remaining 16 consecutive cystectomies with ileal conduit diversion (hand assisted laparoscopic Cystectomy and open Cystectomy in 8 cases each) was performed. Of the 16 cystectomies 13 were performed for muscle invasive bladder cancer. Standard parameters were compared concerning patient operative and postoperative courses using statistical analysis with the 2-tailed t test. A novel surgical technique for completing these HAL procedures is described and compared to standard open Cystectomy and ileal conduit diversion. A total of 16 patients successfully underwent open (8) and HAL (8) Cystectomy with an ileal conduit. Mean estimated blood loss in the HAL and open groups was 637 and 957 cc, respectively (p = 0.23). The mean postoperative parenteral analgesia administered was 31 mg in the HAL group vs 149 mg in the open group (p = 0.01). The HAL and open groups had a mean length of stay of 6.4 vs 9.8 days (p = 0.06). Mean operative time did not differ significantly between the HAL and open groups (403 and 420 minutes, respectively). Regular diet was resumed at 4.5 days in the HAL group vs 7.9 days in the open group (p = 0.05). Hospital length of stay was 6.4 vs 9 days for HAL vs open cases (p = 0.06). To our knowledge this represents the first reported series of patients undergoing HAL Cystectomy with urinary diversion. HAL Cystectomy with an ileal conduit appears to have less estimated blood loss and postoperative analgesic requirements, shorter length of stay and earlier return of bowel function than open Cystectomy. Oncological efficacy was preserved in the short term.
