Skip to main content
Erschienen in: Die Urologie 2/2021

21.01.2021 | Harnblasenkarzinom | Leitthema

Qualitätsparameter bei der radikalen Zystektomie – Chancen, Risiken, Herausforderungen

verfasst von: PD Dr. F. Roghmann, J. Breyer, M. Kriegmair, F. Wezel, M. Burger, J. Noldus, C. Bolenz, Bladder Cancer Research Initiative for Drug Targets Germany (BRIDGE) Consortium e. V.

Erschienen in: Die Urologie | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die radikale Zystektomie (RC) ist die Standardbehandlung des nicht-metastasierten muskelinvasiven Urothelkarzinoms der Harnblase. Sie ist mit einer relevanten Morbidität und Mortalität assoziiert. Nach RC liegt die 5‑Jahres-Gesamtüberlebensrate bei ungefähr 60 %. Im Rahmen der vorliegenden Arbeit sollen Qualitätsparameter der RC identifiziert und unterteilt in onkologische/funktionelle Ergebnisse sowie Komplikationsfreiheit zusammengefasst werden. Es wurde eine PubMed-Recherche durchgeführt. Neben Frühkriterien wie dem Erreichen eines negativen Resektionsrandes, der Durchführung einer Lymphadenektomie, der Anlage einer kontinenten Harnableitung oder dem Erhalt der Sexualfunktion konnten auch Langzeitkriterien wie das Ausbleiben höhergradiger postoperativer Komplikationen, die Rezidivfreiheit und der Erhalt der Lebensqualität identifiziert werden. Die Frühkriterien eignen sich zur individualisierten Therapieplanung im Rahmen der Patientenberatung, wohingegen die Langzeitkriterien zum Qualitätsmonitoring genutzt werden können.
Literatur
3.
Zurück zum Zitat Roghmann F, Trinh Q‑D, Braun K, von Bodman C, Brock M, Noldus J et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149. https://doi.org/10.1111/iju.12232. Epub 2013 Aug 1 Roghmann F, Trinh Q‑D, Braun K, von Bodman C, Brock M, Noldus J et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149. https://​doi.​org/​10.​1111/​iju.​12232. Epub 2013 Aug 1
6.
Zurück zum Zitat Aziz A, Gierth M, Rink M, Schmid M, Chun FK, Dahlem R et al (2015) Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta. World J Urol 33(12):1945–1950. https://doi.org/10.1007/s00345-015-1572-x. Epub 2015 May 7 Aziz A, Gierth M, Rink M, Schmid M, Chun FK, Dahlem R et al (2015) Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta. World J Urol 33(12):1945–1950. https://​doi.​org/​10.​1007/​s00345-015-1572-x. Epub 2015 May 7
9.
Zurück zum Zitat S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms. (AWMF-Registernummer: 032/038OL.Langversion 2.0). S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms. (AWMF-Registernummer: 032/038OL.Langversion 2.0).
10.
Zurück zum Zitat Gore JL, Lai J, Setodji CM, Litwin MS, Saigal CS (2009) Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a surveillance, epidemiology, and end results-medicare analysis. Cancer 115(5):988–996. https://doi.org/10.1002/cncr.24052 Gore JL, Lai J, Setodji CM, Litwin MS, Saigal CS (2009) Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a surveillance, epidemiology, and end results-medicare analysis. Cancer 115(5):988–996. https://​doi.​org/​10.​1002/​cncr.​24052
11.
Zurück zum Zitat Bruins HM, Aben KKH, Arends TJ, van der Heijden AG, Witjes AJ (2016) The effect of the time interval between diagnosis of muscle-invasive bladder cancer and radical cystectomy on staging and survival: a Netherlands Cancer Registry analysis. Urol Oncol 34(4):166.e1–166.e6. https://doi.org/10.1016/j.urolonc.2015.11.006. Epub 2015 Dec 15 Bruins HM, Aben KKH, Arends TJ, van der Heijden AG, Witjes AJ (2016) The effect of the time interval between diagnosis of muscle-invasive bladder cancer and radical cystectomy on staging and survival: a Netherlands Cancer Registry analysis. Urol Oncol 34(4):166.e1–166.e6. https://​doi.​org/​10.​1016/​j.​urolonc.​2015.​11.​006. Epub 2015 Dec 15
12.
13.
14.
Zurück zum Zitat Via KJ, Burns KM, Lamm DL (2010) Tumor implantation: a rare but potentially preventable cause of death in cystectomy patients. Can J Urol 17(3):5216–5218 Via KJ, Burns KM, Lamm DL (2010) Tumor implantation: a rare but potentially preventable cause of death in cystectomy patients. Can J Urol 17(3):5216–5218
16.
Zurück zum Zitat Novotny V, Froehner M, May M, Protzel C, Hergenröther K, Rink M et al (2015) Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World J Urol 33(11):1753–1761. https://doi.org/10.1007/s00345-015-1502-y. Epub 2015 Feb 8 Novotny V, Froehner M, May M, Protzel C, Hergenröther K, Rink M et al (2015) Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World J Urol 33(11):1753–1761. https://​doi.​org/​10.​1007/​s00345-015-1502-y. Epub 2015 Feb 8
17.
Zurück zum Zitat Novara G, Svatek RS, Karakiewicz PI, Skinner E, Ficarra V, Fradet Y et al (2010) Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol 183(6):2165–2170. https://doi.org/10.1016/j.juro.2010.02.021 Novara G, Svatek RS, Karakiewicz PI, Skinner E, Ficarra V, Fradet Y et al (2010) Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol 183(6):2165–2170. https://​doi.​org/​10.​1016/​j.​juro.​2010.​02.​021
19.
Zurück zum Zitat Freeman JA, Tarter TA, Esrig D, Stein JP, Elmajian DA, Chen SC et al (1996) Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 156(5):1615–1619 Freeman JA, Tarter TA, Esrig D, Stein JP, Elmajian DA, Chen SC et al (1996) Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 156(5):1615–1619
21.
22.
Zurück zum Zitat Satkunasivam R, Hu B, Metcalfe C, Ghodoussipour SB, Aron M, Cai J et al (2016) Utility and significance of ureteric frozen section analysis during radical cystectomy. BJUI 117(3):463–468. https://doi.org/10.1111/bju.13081. Epub 2015 Apr 21 Satkunasivam R, Hu B, Metcalfe C, Ghodoussipour SB, Aron M, Cai J et al (2016) Utility and significance of ureteric frozen section analysis during radical cystectomy. BJUI 117(3):463–468. https://​doi.​org/​10.​1111/​bju.​13081. Epub 2015 Apr 21
23.
Zurück zum Zitat Hoang AN, Agarwal PK, Walton-Diaz A, Wood CG, Metwalli AR, Kassouf W et al (2014) Clinical significance of ureteric “skip lesions” at the time of radical cystectomy: The M.D. Anderson experience and literature review. BJU Int 113(5b):E28–E33. https://doi.org/10.1111/bju.12344 Hoang AN, Agarwal PK, Walton-Diaz A, Wood CG, Metwalli AR, Kassouf W et al (2014) Clinical significance of ureteric “skip lesions” at the time of radical cystectomy: The M.D. Anderson experience and literature review. BJU Int 113(5b):E28–E33. https://​doi.​org/​10.​1111/​bju.​12344
24.
Zurück zum Zitat Wallmeroth A, Wagner U, Moch H, Gasser TC, Sauter G, Mihatsch MJ (1999) Patterns of metastasis in muscle-invasive bladder cancer (pT2-4): An autopsy study on 367 patients. Urol Int 62(2):69–75. https://doi.org/10.1159/000030361 Wallmeroth A, Wagner U, Moch H, Gasser TC, Sauter G, Mihatsch MJ (1999) Patterns of metastasis in muscle-invasive bladder cancer (pT2-4): An autopsy study on 367 patients. Urol Int 62(2):69–75. https://​doi.​org/​10.​1159/​000030361
25.
26.
Zurück zum Zitat Dorin RP, Daneshmand S, Eisenberg MS, Chandrasoma S, Cai J, Miranda G et al (2011) Lymph node dissection technique is more important than lymph node count in identifying nodal metastases in radical cystectomy patients: a comparative mapping study. Eur Urol 60(5):946–952. https://doi.org/10.1016/j.eururo.2011.07.012. Epub 2011 Jul 14 Dorin RP, Daneshmand S, Eisenberg MS, Chandrasoma S, Cai J, Miranda G et al (2011) Lymph node dissection technique is more important than lymph node count in identifying nodal metastases in radical cystectomy patients: a comparative mapping study. Eur Urol 60(5):946–952. https://​doi.​org/​10.​1016/​j.​eururo.​2011.​07.​012. Epub 2011 Jul 14
27.
Zurück zum Zitat Bruins HM, Veskimae E, Hernandez V, Imamura M, Neuberger MM, Dahm P et al (2014) The impact of the extent of lymphadenectomy on oncologic outcomes in patients undergoing radical cystectomy for bladder cancer: a systematic review. Eur Urol 66(6):1065–1077. https://doi.org/10.1016/j.eururo.2014.05.031. Epub 2014 Jul 26 Bruins HM, Veskimae E, Hernandez V, Imamura M, Neuberger MM, Dahm P et al (2014) The impact of the extent of lymphadenectomy on oncologic outcomes in patients undergoing radical cystectomy for bladder cancer: a systematic review. Eur Urol 66(6):1065–1077. https://​doi.​org/​10.​1016/​j.​eururo.​2014.​05.​031. Epub 2014 Jul 26
28.
Zurück zum Zitat Landenberg NV, Speed JM, Cole AP, Seisen T, Lipsitz SR, Gild P et al (2018) Impact of adequate pelvic lymph node dissection on overall survival after radical cystectomy: A stratified analysis by clinical stage and receipt of neoadjuvant chemotherapy. Urol Oncol 36(2):78.e13–78.e19. https://doi.org/10.1016/j.urolonc.2017.10.021. Epub 2017 Nov 21 Landenberg NV, Speed JM, Cole AP, Seisen T, Lipsitz SR, Gild P et al (2018) Impact of adequate pelvic lymph node dissection on overall survival after radical cystectomy: A stratified analysis by clinical stage and receipt of neoadjuvant chemotherapy. Urol Oncol 36(2):78.e13–78.e19. https://​doi.​org/​10.​1016/​j.​urolonc.​2017.​10.​021. Epub 2017 Nov 21
29.
Zurück zum Zitat Gschwend JE, Heck MM, Lehmann J, Rübben H, Albers P, Wolff JM et al (2019) Extended versus limited lymph node dissection in bladder cancer patients undergoing radical cystectomy: survival results from a prospective, randomized trial(figure presented.). Eur Urol 75(4):604–611. https://doi.org/10.1016/j.eururo.2018.09.047. Epub 2018 Oct 15 Gschwend JE, Heck MM, Lehmann J, Rübben H, Albers P, Wolff JM et al (2019) Extended versus limited lymph node dissection in bladder cancer patients undergoing radical cystectomy: survival results from a prospective, randomized trial(figure presented.). Eur Urol 75(4):604–611. https://​doi.​org/​10.​1016/​j.​eururo.​2018.​09.​047. Epub 2018 Oct 15
31.
Zurück zum Zitat Zehnder P, Studer UE, Skinner EC, Dorin RP, Cai J, Roth B et al (2011) Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. J Urol 186(4):1261–8. https://doi.org/10.1016/j.juro.2011.06.004. Epub 2011 Aug 17 Zehnder P, Studer UE, Skinner EC, Dorin RP, Cai J, Roth B et al (2011) Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. J Urol 186(4):1261–8. https://​doi.​org/​10.​1016/​j.​juro.​2011.​06.​004. Epub 2011 Aug 17
33.
Zurück zum Zitat Grimm T, Grimm J, Buchner A, Schulz G, Jokisch F, Stief CG et al (2019) Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol 37(11):2385–2392CrossRef Grimm T, Grimm J, Buchner A, Schulz G, Jokisch F, Stief CG et al (2019) Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol 37(11):2385–2392CrossRef
37.
Zurück zum Zitat Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW et al (2004) Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol 172(4 Pt 1):1323–1327. https://doi.org/10.1097/01.ju.0000138249.31644.ec Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW et al (2004) Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol 172(4 Pt 1):1323–1327. https://​doi.​org/​10.​1097/​01.​ju.​0000138249.​31644.​ec
38.
40.
Zurück zum Zitat Danna BJ, Metcalfe MJ, Wood EL, Shah JB (2016) Assessing symptom burden in bladder cancer: an overview of bladder cancer specific health-related quality of life instruments. Bladder Cancer 2(3):329–340. https://doi.org/10.3233/BLC-160057 Danna BJ, Metcalfe MJ, Wood EL, Shah JB (2016) Assessing symptom burden in bladder cancer: an overview of bladder cancer specific health-related quality of life instruments. Bladder Cancer 2(3):329–340. https://​doi.​org/​10.​3233/​BLC-160057
41.
46.
Zurück zum Zitat Vetterlein MW, Klemm J, Gild P, Bradtke M, Soave A, Dahlem R et al (2020) Improving estimates of perioperative morbidity after radical cystectomy using the European Association of Urology quality criteria for standardized reporting and introducing the comprehensive complication index[formula presented. Eur Urol 77(1):55–65. https://doi.org/10.1016/j.eururo.2019.08.011. Epub 2019 Aug 29 Vetterlein MW, Klemm J, Gild P, Bradtke M, Soave A, Dahlem R et al (2020) Improving estimates of perioperative morbidity after radical cystectomy using the European Association of Urology quality criteria for standardized reporting and introducing the comprehensive complication index[formula presented. Eur Urol 77(1):55–65. https://​doi.​org/​10.​1016/​j.​eururo.​2019.​08.​011. Epub 2019 Aug 29
47.
Zurück zum Zitat Wessels F, Lenhart M, Kowalewski KF, Braun V, Terboven T, Roghmann F et al (2020) Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World J Urol 38(12):3139–3153. https://doi.org/10.1007/s00345-020-03133-y. Epub 2020 Mar 2 Wessels F, Lenhart M, Kowalewski KF, Braun V, Terboven T, Roghmann F et al (2020) Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World J Urol 38(12):3139–3153. https://​doi.​org/​10.​1007/​s00345-020-03133-y. Epub 2020 Mar 2
Metadaten
Titel
Qualitätsparameter bei der radikalen Zystektomie – Chancen, Risiken, Herausforderungen
verfasst von
PD Dr. F. Roghmann
J. Breyer
M. Kriegmair
F. Wezel
M. Burger
J. Noldus
C. Bolenz
Bladder Cancer Research Initiative for Drug Targets Germany (BRIDGE) Consortium e. V.
Publikationsdatum
21.01.2021
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 2/2021
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-020-01439-8

Weitere Artikel der Ausgabe 2/2021

Die Urologie 2/2021 Zur Ausgabe

Termine

Termine

Urologische Pflege

Nähe auf Distanz

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.