Outcomes. Glickman Urological & Kidney Institute

Transcription

1 Outcomes 28 Glickman Urological & Kidney Institute

2 Prostate Cryotherapy Cryotherapy has recently been used for treatment of prostate cancer as primary treatment and after failure of radiation treatment. Treatment results are encouraging, with minimal complications and excellent biochemical response rate. Bladder Cancer The number of patients treated for bladder cancer steadily increased over the last few years. Patients with superficial, muscle-invasive, as well as advanced and metastatic diseases are managed according to modern guidelines with excellent outcomes. The urologic oncologists at the Glickman Urological & Kidney Institute performed more than 6 cystoscopic resection procedures and approximately 15 radical cystectomy operations in 28. Laparoscopic radical cystectomy is offered to select patients, offering the advantage of less postoperative pain and shorter recovery. Data source for the following information is departmental bladder cancer database. Transurethral Resection of Bladder Volume 1, Modern continent urinary diversion techniques are performed for patients who prefer to avoid external collecting appliances. Systemic chemotherapy is used in conjunction with surgery in an adjuvant or neoadjuvant manner in select patients with high risk or advanced disease. Overall surgical mortality for patients undergoing cystectomy is around one percent, with no mortality in patients younger than 6 years old. Glickman Urological & Kidney Institute 51

3 Urologic Oncology Perioperative Mortality Following Radical Cystoprostatectomy Percent Average Blood Loss cc/ml 1,5 1, Outcomes 28

4 Average Length of Stay Following Radical Cystoprostatectomy Days Radical Cystectomy Volume Continent Diversion Ileal Conduit Open Radical Cystectomy Volume Glickman Urological & Kidney Institute 53

5 Urologic Oncology Laparoscopic Cystectomy Volume Laparoscopic Cystectomy Procedures 1, EBL Length of Stay 1 Linear (EBL) Outcomes 28

6 Laparoscopic and Robotic Radical Cystectomy Minimally invasive surgical techniques attempt to duplicate the excellent oncological outcomes of open radical cystectomy with a superior patient recovery profile: decreased blood loss, shorter hospital stay and quicker convalescence. Our institutional experience with laparoscopic and robotic radical cystectomy exceeds 9 cases, 18 of which have been done robotically. We recently compared the perioperative outcomes of laparoscopic-assisted radical cystectomy (N = 5) with a contemporary cohort of open radical cystectomy (N = 5). Table illustrates the comparative data of the two cohorts from Laparoscopic radical cystectomy N = 5 Open radical cystectomy N = 5 P.1 Number 5 5 Operative time (hrs) 6.3± ±.28.1 Blood loss (cc) 363±259 81±684.4 Transfusion (%) 12% 4%.1 Ileus (%) 16% 3%.9 Oral intake (days) 3.4± ±2.1.4 Minor postop complications (%) 18% 22%.62 Major postop complications (%) 8% 6%.69 Ambulation (days) 3.± ± Hospital stay (days) 8.± ± Lymph nodes on final pathology (n) 14.8± ± Positive surgical margins (%) 2% 6%.29 Haber GP, Campbell SC, Colombo JR Jr, Gianduzzo T, Aron M, Fergany A, Kaouk J, Gill IS. Comparison between Open and Laparoscopic Assisted Radical Cystectomy for Bladder Cancer. (Urology November 27) Glickman Urological & Kidney Institute 55

7 Institute Locations Main Campus 95 Euclid Ave. Cleveland, OH Elyria Memorial Hospital 125 E. Broad St., Suite 28 Elyria, OH Avon Lake Family Health Center 45 Avon Belden Road Avon Lake, OH Beachwood Family Health and Surgery Center 269 Cedar Road, Suite 36 Beachwood, OH Charleston, West Virginia Charleston Area Medical Center 121 Washington Street East, Suite 1 Charleston, WV Cleveland Clinic in Florida 295 Cleveland Clinic Boulevard Weston, Florida Euclid Hospital Medical Office Building 99 Northline Circle, Suite 21 Euclid, OH Fairview Hospital 1811 Lorain Ave. Cleveland, OH Hillcrest Urology Hillcrest Hospital Atrium 677 Mayfield Road, Suite 226 Mayfield Heights, OH Huron Hospital Terrace Road East Cleveland, OH Glickman Urological & Kidney Institute 127

8 Institute Locations Independence Family Health Center 51 Rockside Road Crown Centre II Independence, OH Lakewood Hospital INA Building 1471 Detroit Ave., Suite 64 Lakewood, OH Lorain Family Health and Surgery Center 57 Cooper Foster Park Road Lorain, OH Marymount Hospital 123 McCracken Road Garfield Heights, OH Urology at Mayfield Hillcrest Hospital Atrium 677 Mayfield Road, Suite 237 Mayfield Heights, OH Outcomes 28

9 Parma Community General Hospital 77 Powers Blvd. Parma, OH St. Vincent Indianapolis Hospital 21 W. 86th St. Indianapolis, IN Solon Family Health Center 298 Bainbridge Road Solon, OH Strongsville Family Health and Surgery Center SouthPark Center Strongsville, OH Westlake Family Health Center 333 Clemens Road Westlake, OH Glickman Urological & Kidney Institute 129