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MP67-01 SARCOPENIA AS A PREDICTOR OF CANCER-SPECIFIC AND OVERALL SURVIVAL AFTER RADICAL CYSTECTOMY: IS THERE A GENDER INFLUENCE?
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
simple cystectomy be performed simultaneously, to avoid the complications of bleeding, pain, pyocystis and secondary urothelial carcinoma. These complications occur in 54-80% of patients left with a native bladder after diversion, and completion cystectomy is performed in 20 to 25% of patients. These complications may be avoided by performance of simple cystectomy at the time of urinary diversion. This operation has been described only via open approach. We present here a technique of successful robotic-assisted simple cystectomy performed at the time of urinary diversion. METHODS: This patient is a 46yo female who was scheduled for robotice assisted hysterectomy, end colostomy and urinary diversion for the urologic indications of pain and intractable fecal and urinary incontinence. She had experienced severe infectious complications in the setting of previous spinal injury and an extensive smoking history. The patient underwent planned robotic e assisted hysterectomy for separate gynecological indications via a separate team at the same setting. The colon was mobilized and transected to produce adequate length for end colostomy, as well as appropriate distal sigmoid colon for urinary diversion without re-anastomosis. Robotic ureteral dissection and stented uretero-intestinal anastomoses were performed with the sigmoid conduit in an isoperistaltic orientation. Once this was successfully completed, simple cystectomy was performed as follows: 1. The bladder was dissected free from surrounding peritoneal attachments. 2. A midline incision was utilized to bivalve the bladder. 3. The submucosal plane was identified and simple cystectomy executed. 4. All resected mucosa and suprapubic tract is carefully removed in a specimen bag and sent for pathologic analysis. 5. The ostomies were matured and port sites closed. RESULTS: Surgical time for simple cystectomy was 48 minutes. Estimated blood loss for this portion of the procedure was unquantifiable, but was considered to be under 10 mL as essentially no bleeding was encountered. The patient was discharged without complication. CONCLUSIONS: Robotic-assisted simple cystectomy is expedient and recapitulates the principles of the open procedure. Decreases in surgical time would be anticipated as experience increases. Larger series and long-term follow-up is required. Source of Funding: None
V10-14 ROBOTIC NEPHROLITHOTOMY: VARIOUS TECHNIQUES FOR EXTRACTION Matthew Sterling*, Philadelphia, PA; Phillip Mucksavage, philadelphia, PA INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is the current gold standard for staghorn and large renal pelvis (>2cm) calculi. Robotic nephrolithotomy is an alternative option in patients with additional pathology precluding PCNL and in those where primary PCNL fails. We utilized Fireflyâ technology to assist in removal of large renal calculi in patients who had failed PCNL or had additional pathology. METHODS: Robotic assisted nephrolithotomy was performed on 3 patients using various minimally invasive stone extraction techniques. This includes use of Fireflyâ technology in combination with antegrade ureteroscopy. RESULTS: A total of 3 patients underwent robotic-assisted nephrolithomy with stone free rates of 100%. In all 3 procedures Fireflyâ technology was utilized via ureteroscopy to guide to the exact
e849
location of the stone. Two patients had failed PCNL. In another patient, a large cyst decortication followed by stone removal was performed. All patients were discharged on post-operative day 1 with an indwelling JJ stent. No patient was readmitted within 30 days and there were no perioperative complications. CONCLUSIONS: Robotic-assisted nephrolithotomy is an attractive option for large renal stones in patients that either fail primary PCNL or if additional pathology exists that precludes PCNL. Stone free rates are high with low morbidity and quick recovery. Source of Funding: none
Bladder Cancer: Invasive IV Moderated Poster 67 Monday, May 18, 2015
1:00 PM-3:00 PM
MP67-01 SARCOPENIA AS A PREDICTOR OF CANCER-SPECIFIC AND OVERALL SURVIVAL AFTER RADICAL CYSTECTOMY: IS THERE A GENDER INFLUENCE? Ahmed Harraz*, Yasser Osman, Islam Fakhreldin, Osama Mahmoud, Mona El-Deeb, Mahmoud Laymon, Ahmed Mosbah, Hassan Abol-Enein, Atallah Shaaban, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: Sarcopenia is a novel emerging predictor of mortality after cancer surgery. However, published data on the untoward effect of sarcopenia in patients with bladder cancer are few and were derived from studies with a relatively low number of patients. In addition, no previous studies has explored sarcopenia outcome stratified by gender. We evaluated sarcopenia as a predictor for cancer-specific (CSS) and overall survival (OS) in a large series. METHODS: A retrospective analysis of electronic database for patients underwent radical cystectomy, between January 2004 and January 2008, for muscle invasive bladder cancer was performed. Only patients with available preoperative computerized tomography scan (CT) and survival data were included. Patients with missed follow-up or those with missing data were excluded. Total psoas area (TPA) score was calculated using preoperative CT and was adjusted for the height (cm2/m2). Cut-off values for men and women were developed using Receiver Operating Characteristic (ROC) curves and were used to investigate the impact of sarcopenia on CSS and OS by univariate and multivariate analyses. RESULTS: A total of 460 patients were included in the analysis during the specified period. The mean SD adjusted-TPA scores for men and women were 58.8 21.5 and 37 12 cm2/m2, respectively (p < 0.001). An adjusted-TPA scores 53.5 cm2/m2 and 37.4 cm2/m2 were identified as cut-off values to define sarcopenia in men and women, respectively. Men with sarcopenia showed significantly worse 5-year CSS than men without sarcopenia (66.7% vs 77.8%; p ¼ 0.01). On multivariate analysis, sarcopenia (Hazards ratio [HR]: 1.7; 95% confidence interval [CI]: 1.1-2.5; p ¼ 0.01) was an independent predictor of 5-year CSS. Similarly, the 5-year OS was significantly worse in men with sarcopenia vs those with no sarcopenia (33.3% vs 40%; p ¼ 0.005). On multivariate analysis, sarcopenia was an independent predictor for 5-year OS (HR: 1.3; 95%CI: 1.1-1.6; p ¼ 0.02). On the other hand, women without sarcopenia did not show neither 5-year CSS benefit (75% vs 80%; p ¼ 0.06) nor 5-year OS benefit (36% vs 55%; p ¼ 0.1). CONCLUSIONS: Sarcopenia in men is an independent predictor of cancer-specific and overall survival after radical cystectomy. Further research would confirm sarcopenia as a useful predictor of mortality after radical cystectomy would suggest the development of new nomograms for better cancer outcome prediction. Source of Funding: none
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
simple cystectomy be performed simultaneously, to avoid the complications of bleeding, pain, pyocystis and secondary urothelial carcinoma. These complications occur in 54-80% of patients left with a native bladder after diversion, and completion cystectomy is performed in 20 to 25% of patients. These complications may be avoided by performance of simple cystectomy at the time of urinary diversion. This operation has been described only via open approach. We present here a technique of successful robotic-assisted simple cystectomy performed at the time of urinary diversion. METHODS: This patient is a 46yo female who was scheduled for robotice assisted hysterectomy, end colostomy and urinary diversion for the urologic indications of pain and intractable fecal and urinary incontinence. She had experienced severe infectious complications in the setting of previous spinal injury and an extensive smoking history. The patient underwent planned robotic e assisted hysterectomy for separate gynecological indications via a separate team at the same setting. The colon was mobilized and transected to produce adequate length for end colostomy, as well as appropriate distal sigmoid colon for urinary diversion without re-anastomosis. Robotic ureteral dissection and stented uretero-intestinal anastomoses were performed with the sigmoid conduit in an isoperistaltic orientation. Once this was successfully completed, simple cystectomy was performed as follows: 1. The bladder was dissected free from surrounding peritoneal attachments. 2. A midline incision was utilized to bivalve the bladder. 3. The submucosal plane was identified and simple cystectomy executed. 4. All resected mucosa and suprapubic tract is carefully removed in a specimen bag and sent for pathologic analysis. 5. The ostomies were matured and port sites closed. RESULTS: Surgical time for simple cystectomy was 48 minutes. Estimated blood loss for this portion of the procedure was unquantifiable, but was considered to be under 10 mL as essentially no bleeding was encountered. The patient was discharged without complication. CONCLUSIONS: Robotic-assisted simple cystectomy is expedient and recapitulates the principles of the open procedure. Decreases in surgical time would be anticipated as experience increases. Larger series and long-term follow-up is required. Source of Funding: None
V10-14 ROBOTIC NEPHROLITHOTOMY: VARIOUS TECHNIQUES FOR EXTRACTION Matthew Sterling*, Philadelphia, PA; Phillip Mucksavage, philadelphia, PA INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is the current gold standard for staghorn and large renal pelvis (>2cm) calculi. Robotic nephrolithotomy is an alternative option in patients with additional pathology precluding PCNL and in those where primary PCNL fails. We utilized Fireflyâ technology to assist in removal of large renal calculi in patients who had failed PCNL or had additional pathology. METHODS: Robotic assisted nephrolithotomy was performed on 3 patients using various minimally invasive stone extraction techniques. This includes use of Fireflyâ technology in combination with antegrade ureteroscopy. RESULTS: A total of 3 patients underwent robotic-assisted nephrolithomy with stone free rates of 100%. In all 3 procedures Fireflyâ technology was utilized via ureteroscopy to guide to the exact
e849
location of the stone. Two patients had failed PCNL. In another patient, a large cyst decortication followed by stone removal was performed. All patients were discharged on post-operative day 1 with an indwelling JJ stent. No patient was readmitted within 30 days and there were no perioperative complications. CONCLUSIONS: Robotic-assisted nephrolithotomy is an attractive option for large renal stones in patients that either fail primary PCNL or if additional pathology exists that precludes PCNL. Stone free rates are high with low morbidity and quick recovery. Source of Funding: none
Bladder Cancer: Invasive IV Moderated Poster 67 Monday, May 18, 2015
1:00 PM-3:00 PM
MP67-01 SARCOPENIA AS A PREDICTOR OF CANCER-SPECIFIC AND OVERALL SURVIVAL AFTER RADICAL CYSTECTOMY: IS THERE A GENDER INFLUENCE? Ahmed Harraz*, Yasser Osman, Islam Fakhreldin, Osama Mahmoud, Mona El-Deeb, Mahmoud Laymon, Ahmed Mosbah, Hassan Abol-Enein, Atallah Shaaban, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: Sarcopenia is a novel emerging predictor of mortality after cancer surgery. However, published data on the untoward effect of sarcopenia in patients with bladder cancer are few and were derived from studies with a relatively low number of patients. In addition, no previous studies has explored sarcopenia outcome stratified by gender. We evaluated sarcopenia as a predictor for cancer-specific (CSS) and overall survival (OS) in a large series. METHODS: A retrospective analysis of electronic database for patients underwent radical cystectomy, between January 2004 and January 2008, for muscle invasive bladder cancer was performed. Only patients with available preoperative computerized tomography scan (CT) and survival data were included. Patients with missed follow-up or those with missing data were excluded. Total psoas area (TPA) score was calculated using preoperative CT and was adjusted for the height (cm2/m2). Cut-off values for men and women were developed using Receiver Operating Characteristic (ROC) curves and were used to investigate the impact of sarcopenia on CSS and OS by univariate and multivariate analyses. RESULTS: A total of 460 patients were included in the analysis during the specified period. The mean SD adjusted-TPA scores for men and women were 58.8 21.5 and 37 12 cm2/m2, respectively (p < 0.001). An adjusted-TPA scores 53.5 cm2/m2 and 37.4 cm2/m2 were identified as cut-off values to define sarcopenia in men and women, respectively. Men with sarcopenia showed significantly worse 5-year CSS than men without sarcopenia (66.7% vs 77.8%; p ¼ 0.01). On multivariate analysis, sarcopenia (Hazards ratio [HR]: 1.7; 95% confidence interval [CI]: 1.1-2.5; p ¼ 0.01) was an independent predictor of 5-year CSS. Similarly, the 5-year OS was significantly worse in men with sarcopenia vs those with no sarcopenia (33.3% vs 40%; p ¼ 0.005). On multivariate analysis, sarcopenia was an independent predictor for 5-year OS (HR: 1.3; 95%CI: 1.1-1.6; p ¼ 0.02). On the other hand, women without sarcopenia did not show neither 5-year CSS benefit (75% vs 80%; p ¼ 0.06) nor 5-year OS benefit (36% vs 55%; p ¼ 0.1). CONCLUSIONS: Sarcopenia in men is an independent predictor of cancer-specific and overall survival after radical cystectomy. Further research would confirm sarcopenia as a useful predictor of mortality after radical cystectomy would suggest the development of new nomograms for better cancer outcome prediction. Source of Funding: none