TY - JOUR
T1 - Do perioperative blood transfusions impact oncological outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion? Results from a large multi-institutional registry
AU - Sarkis, Julien
AU - Diamand, Romain
AU - Aoun, Fouad
AU - Assenmacher, Gregoire
AU - Assenmacher, Christophe
AU - Verhoest, Gregory
AU - Holz, Serge
AU - Naudin, Michel
AU - Ploussard, Guillaume
AU - Mari, Andrea
AU - Minervini, Andrea
AU - Tay, Andrea
AU - Issa, Rami
AU - Roumiguié, Mathieu
AU - Bajeot, Anne S.
AU - Simone, Giuseppe
AU - Anceschi, Umberto
AU - Umari, Paolo
AU - Sridhar, Ashwin
AU - Kelly, John
AU - Hendricksen, Kees
AU - Einerhand, Sarah
AU - Mertens, Laura S.
AU - Sanchez-Salas, Rafael
AU - Colomer, Anna
AU - Quackels, Thierry
AU - Peltier, Alexandre
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Pradere, Benjamin
AU - Moschini, Marco
AU - Roumeguère, Thierry
AU - European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group
AU - Albisinni, Simone
N1 - Publisher Copyright: © 2022 EDIZIONI MINERVA MEDICA.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - BACKGROUND: Blood transfusions (BT) have been associated with adverse oncologic outcomes in multiple malignancies including open radical cystectomy (ORC) for urothelial carcinoma of the bladder (UCB). Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) delivers similar oncologic outcomes compared to ORC, yet with lower blood loss and reduced transfusions. However, the impact of BT after robotic cystectomy is still unknown. METHODS: This is a multicenter study including patients treated for UCB with RARC and ICUD in 15 academic institutions, between January 2015 and January 2022. BT were administered during surgery (intraoperative blood transfusions, iBT) or during the first 30 days after surgery (post-operative blood transfusions, pBT). The association of iBT and pBT with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated by univariate and multivariate regression analysis. RESULTS: A total of 635 patients were included in the study. Overall, 35/635 patients (5.51%) received iBT while 70/635 (11.0%) received pBT. After a mean follow-up of 23±18 months, 116 patients (18.3%) had died, including 96 (15.1%) from bladder cancer. Recurrence occurred in 146 patients (23%). iBT were associated with decreased RFS, CSS and OS (P<0.001) on univariate Cox analysis. After adjusting for clinicopathologic covariates, iBT were associated only with the risk of recurrence (HR: 1.7; 95% CI, 1.0-2.8, P=0.04). pBT were not significantly associated to RFS, CSS or OS on univariate and multivariate Cox regression models (P>0.05). CONCLUSIONS: In the present study, patients treated by RARC with ICUD for UCB have a higher risk of recurrence after iBT, yet no significant association with CSS and OS was found. pBT are not associated with worse oncological prognosis.
AB - BACKGROUND: Blood transfusions (BT) have been associated with adverse oncologic outcomes in multiple malignancies including open radical cystectomy (ORC) for urothelial carcinoma of the bladder (UCB). Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) delivers similar oncologic outcomes compared to ORC, yet with lower blood loss and reduced transfusions. However, the impact of BT after robotic cystectomy is still unknown. METHODS: This is a multicenter study including patients treated for UCB with RARC and ICUD in 15 academic institutions, between January 2015 and January 2022. BT were administered during surgery (intraoperative blood transfusions, iBT) or during the first 30 days after surgery (post-operative blood transfusions, pBT). The association of iBT and pBT with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated by univariate and multivariate regression analysis. RESULTS: A total of 635 patients were included in the study. Overall, 35/635 patients (5.51%) received iBT while 70/635 (11.0%) received pBT. After a mean follow-up of 23±18 months, 116 patients (18.3%) had died, including 96 (15.1%) from bladder cancer. Recurrence occurred in 146 patients (23%). iBT were associated with decreased RFS, CSS and OS (P<0.001) on univariate Cox analysis. After adjusting for clinicopathologic covariates, iBT were associated only with the risk of recurrence (HR: 1.7; 95% CI, 1.0-2.8, P=0.04). pBT were not significantly associated to RFS, CSS or OS on univariate and multivariate Cox regression models (P>0.05). CONCLUSIONS: In the present study, patients treated by RARC with ICUD for UCB have a higher risk of recurrence after iBT, yet no significant association with CSS and OS was found. pBT are not associated with worse oncological prognosis.
KW - Blood transfusion
KW - Cystectomy
KW - Robotic surgical procedures
KW - Urinary bladder neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85148309115&partnerID=8YFLogxK
U2 - https://doi.org/10.23736/S2724-6051.22.05109-6
DO - https://doi.org/10.23736/S2724-6051.22.05109-6
M3 - Article
C2 - 36800680
SN - 2724-6051
VL - 75
SP - 50
EP - 58
JO - Minerva Urology and Nephrology
JF - Minerva Urology and Nephrology
IS - 1
ER -