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En bloc radical cystectomy: An overview of the technique and oncological results

OBJECTIVES: To reduce recurrence after radical cystectomy (RC), we developed a technique based on the principles of the circumferential resection margin used during total mesorectal excision for rectal cancer, namely, en bloc radical cystectomy (EbRC). PATIENTS AND METHODS: The study included all pa...

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Autores principales: Kjøbli, Eirik, Salvesen, Øyvind, Langørgen, Sverre, Størkersen, Øystein, Wibe, Arne, Arum, Carl‐Jørgen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931536/
https://www.ncbi.nlm.nih.gov/pubmed/36816150
http://dx.doi.org/10.1002/bco2.190
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author Kjøbli, Eirik
Salvesen, Øyvind
Langørgen, Sverre
Størkersen, Øystein
Wibe, Arne
Arum, Carl‐Jørgen
author_facet Kjøbli, Eirik
Salvesen, Øyvind
Langørgen, Sverre
Størkersen, Øystein
Wibe, Arne
Arum, Carl‐Jørgen
author_sort Kjøbli, Eirik
collection PubMed
description OBJECTIVES: To reduce recurrence after radical cystectomy (RC), we developed a technique based on the principles of the circumferential resection margin used during total mesorectal excision for rectal cancer, namely, en bloc radical cystectomy (EbRC). PATIENTS AND METHODS: The study included all patients in Mid‐Norway (population of 739 k) with high‐grade superficial or muscle invasive bladder cancer considered for radical treatment according to European guidelines, from January 2012 to August 2021, except for three patients receiving trimodal therapy. One hundred forty‐five patients were treated with EbRC and 188 patients with standard RC (stdRC). There were no exclusion criteria. Both groups included open and robot‐assisted techniques. EbRC entails cystectomy with extended pelvic lymph node dissection. The technique focuses on systematic uninterrupted mobilisation of all lymphatic tissue from the circumferential resection margin towards the bladder pedicles, and resecting the tissue en bloc with the bladder. RESULTS: The 3‐year recurrence‐free survival (RFS) was 86% for EbRC versus 67% for stdRC. The hazard ratio for overall survival in multivariable cox regression analyses after EbRC versus stdRC was 0.30 (95% CI 0.16–0.57, p ≤ 0.001). The improved outcomes persisted in propensity score‐matched analyses. There were no differences in Clavien–Dindo 3 and 4 complications (12.4% vs. 11.7%), nor 90‐day mortality (2.1% vs. 1.6%). CONCLUSION: Improved oncological results with EbRC versus stdRC mirror the historical data after total mesorectal excision was initiated over 35 years ago in rectal cancer surgery. EbRC is safe and the preliminary oncological results are promising.
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spelling pubmed-99315362023-02-17 En bloc radical cystectomy: An overview of the technique and oncological results Kjøbli, Eirik Salvesen, Øyvind Langørgen, Sverre Størkersen, Øystein Wibe, Arne Arum, Carl‐Jørgen BJUI Compass Original Articles OBJECTIVES: To reduce recurrence after radical cystectomy (RC), we developed a technique based on the principles of the circumferential resection margin used during total mesorectal excision for rectal cancer, namely, en bloc radical cystectomy (EbRC). PATIENTS AND METHODS: The study included all patients in Mid‐Norway (population of 739 k) with high‐grade superficial or muscle invasive bladder cancer considered for radical treatment according to European guidelines, from January 2012 to August 2021, except for three patients receiving trimodal therapy. One hundred forty‐five patients were treated with EbRC and 188 patients with standard RC (stdRC). There were no exclusion criteria. Both groups included open and robot‐assisted techniques. EbRC entails cystectomy with extended pelvic lymph node dissection. The technique focuses on systematic uninterrupted mobilisation of all lymphatic tissue from the circumferential resection margin towards the bladder pedicles, and resecting the tissue en bloc with the bladder. RESULTS: The 3‐year recurrence‐free survival (RFS) was 86% for EbRC versus 67% for stdRC. The hazard ratio for overall survival in multivariable cox regression analyses after EbRC versus stdRC was 0.30 (95% CI 0.16–0.57, p ≤ 0.001). The improved outcomes persisted in propensity score‐matched analyses. There were no differences in Clavien–Dindo 3 and 4 complications (12.4% vs. 11.7%), nor 90‐day mortality (2.1% vs. 1.6%). CONCLUSION: Improved oncological results with EbRC versus stdRC mirror the historical data after total mesorectal excision was initiated over 35 years ago in rectal cancer surgery. EbRC is safe and the preliminary oncological results are promising. John Wiley and Sons Inc. 2022-09-18 /pmc/articles/PMC9931536/ /pubmed/36816150 http://dx.doi.org/10.1002/bco2.190 Text en © 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Kjøbli, Eirik
Salvesen, Øyvind
Langørgen, Sverre
Størkersen, Øystein
Wibe, Arne
Arum, Carl‐Jørgen
En bloc radical cystectomy: An overview of the technique and oncological results
title En bloc radical cystectomy: An overview of the technique and oncological results
title_full En bloc radical cystectomy: An overview of the technique and oncological results
title_fullStr En bloc radical cystectomy: An overview of the technique and oncological results
title_full_unstemmed En bloc radical cystectomy: An overview of the technique and oncological results
title_short En bloc radical cystectomy: An overview of the technique and oncological results
title_sort en bloc radical cystectomy: an overview of the technique and oncological results
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931536/
https://www.ncbi.nlm.nih.gov/pubmed/36816150
http://dx.doi.org/10.1002/bco2.190
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