Predictors and survival benefit of achieving pentafecta in a contemporary series of open radical cystectomy
| Autor: | Ahmed M. Harraz, Atallah A. Shaaban, Ahmed Mosbah, Abdelwahab Hashem, Amr A. Elsawy, Hassan Abol-Enein, Mahmoud Laymon |
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| Rok vydání: | 2022 |
| Předmět: |
Surgical margin
Series (stratigraphy) medicine.medical_specialty Multivariate analysis Blood transfusion business.industry Urology medicine.medical_treatment Urinary diversion Margins of Excision Perioperative Cystectomy Surgery Treatment Outcome Robotic Surgical Procedures Urinary Bladder Neoplasms Nephrology medicine Humans Complication business Retrospective Studies |
| Zdroj: | Minerva Urology and Nephrology. 74 |
| ISSN: | 2724-6442 2724-6051 |
| DOI: | 10.23736/s2724-6051.21.04230-0 |
| Popis: | Background Pentafecta provides a comprehensive approach for standardized reporting of surgical and oncologic outcomes after radical cystectomy and urinary diversion. We aimed to report the rate, predictors of achieving pentafecta and its impact on long-term survival in a contemporary series of open radical cystectomy (ORC). Methods A retrospective analysis of a computerized database of patients treated with ORC between 2004 till 2014 was performed. Pentafecta criteria included negative soft tissue surgical margin (STSM), retrieval of ≥ 16 lymph nodes, absence of clinical recurrence within 12 months after surgery, absence of high-grade complication (GIII-V) within 90 days after surgery, and absence of urinary diversion related complications at 12 months follow up. Multivariate analysis was used to identify predictors of achieving pentafecta. Results Pentafecta was achieved in 545 (33.6%) patients out of 1624 included in the study. Absence of ≥16 LN yield was the first cause of missing pentafecta (49.5%). Multivariate analysis identified: ASA score grades ≥ III (OR=0.7, 95%CI 0.6-0.9, P=0.04), BMI ≥ 35 (OR=0.5, 95%CI 0.3-0.8, P=0.007), perioperative blood transfusion (≥ 4 units) (OR=0.5, 95%CI 0.3-0.7, P=0.001), and ileal conduit (OR=0.7, 95%CI 0.5-0.9, P= 0.01) as independent predictors of missing pentafecta. Patients who achieved pentafecta had higher estimated 5-year RFS than their counterparts (81.7% vs 62.5%; p Conclusions Pentafecta was achieved in nearly one third of patients after ORC. Achievement of pentafecta was associated with better long-term recurrence-free survival. Obesity (class II, III), perioperative blood transfusion (> 4 units), associated comorbidities, and ileal conduit were independent predictors of missing pentafecta. |
| Databáze: | OpenAIRE |
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