Faculty Collaboration Database

Perioperative and long-term outcomes after radical cystectomy in hemodialysis patients. Urol Oncol 2018 May;36(5):237.e19-237.e24

Date

02/06/2018

Pubmed ID

29395954

DOI

10.1016/j.urolonc.2017.12.024

Scopus ID

2-s2.0-85040661781 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

PURPOSE: Patients on hemodialysis have an increased risk of developing advanced stage bladder cancer. They also have a significant risk of noncancer-related mortality. Radical cystectomy (RC) is the standard of care for nonmetastatic muscle-invasive bladder cancer, however little is known regarding outcomes in this population.

MATERIALS AND METHODS: The United States Renal Disease System database was used to identify all patients on hemodialysis who underwent RC for bladder cancer in the United States between 1984 and 2013. A total of 985 patients were identified for analysis. Perioperative outcomes were evaluated. Competing risks analysis was used to estimate overall and cancer-specific mortality along with factors associated with death.

RESULTS: Median hospital length of stay was 10 days and 43.1% of patients experienced a complication. Mortality within 30 days was 9.3%. Overall mortality at 1, 3, and 5 years was 51.7%, 77.3%, and 87.9%, respectively. Cancer-specific mortality at 1, 3, and 5 years was 12.3%, 18.4%, and 19.7%, respectively. Age, diabetes, and cerebrovascular disease were independently associated with overall mortality, while performance of urinary diversion was associated with a protective effect. Active smoking was the sole risk factor for cancer-specific mortality.

CONCLUSIONS: RC in dialysis patients is associated with significant morbidity and mortality, with less than 15% overall survival at 5 years. Older patients, and those with a history of diabetes or cerebrovascular disease, are at an increased risk of mortality.

Author List

Johnson SC, Smith ZL, Golan S, Rodriguez JF 3rd, Pearce SM, Smith ND, Steinberg GD

Author

Scott C. Johnson MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cystectomy
Databases, Factual
Female
Follow-Up Studies
Humans
Length of Stay
Male
Morbidity
Perioperative Care
Postoperative Complications
Prognosis
Renal Dialysis
Risk Factors
Survival Rate
Urinary Bladder Neoplasms