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Journal of clinical medicine
Oct 30, 2023;12 (21):

Evidence-Based Analysis of the Critical Steps of Radical Cystectomy for Bladder Cancer.

Vincent D D'Andrea, Kevin Melnick, Kendrick Yim, John Ernandez, Nnamdi Onochie, Timothy N Clinton, Graeme S Steele, Mark A Preston, Adam S Kibel, Matthew Mossanen
Author Information
  1. Vincent D D'Andrea: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA. ORCID
  2. Kevin Melnick: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  3. Kendrick Yim: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  4. John Ernandez: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  5. Nnamdi Onochie: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  6. Timothy N Clinton: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  7. Graeme S Steele: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  8. Mark A Preston: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  9. Adam S Kibel: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
  10. Matthew Mossanen: Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA.
PMID: 37959309 DOI: 10.3390/jcm12216845

Abstract

Radical cystectomy (RC) is an integral part of the management of patients with advanced-stage bladder cancer. This major oncologic operation is prone to complications resulting in morbidity and mortality. We analyzed the critical steps of open RC, performed an evidence-based review of these steps, and discussed our experience and approach. We conducted a literature review of the open RC technique, identified the critical steps that consistently appeared across different sources, and organized these steps into a framework. PubMed was queried with the critical steps as keywords for relevant articles published from 1 January 2013 to 1 August 2023. We utilized this query to conduct a systematic review of the literature using the outcomes of overall survival and 90-day complication rate. We developed the "Summary for the 10 Critical Operative Steps of Radical Cystectomy", a concise guide to the approach to open RC. When available, an evidence-based analysis of each critical step was performed. We also included additional components of cystectomy optimization such as pre-habilitation in the preoperative phase, standard versus extended lymphadenectomy, the vaginal-sparing approach to female radical cystectomy, patient-reported outcomes following urinary diversion, the use of a mesh for stoma formation, and the use of the ERAS protocol for postoperative care. An evidence-based assessment of RC may help provide valuable information to optimize surgical techniques and patient outcomes.

Keywords

bladder cancer radical cystectomy surgical outcomes surgical technique urologic oncology

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