Long-term outcomes of complete urinary tract exenteration for dialysis patients with urothelial cancer.
OBJECTIVE
To survey long-term outcomes of dialysis patients with urothelial cancers who have undergone complete urinary tract exenteration (bilateral nephroureterectomy and cystectomy).


METHODS
We retrospectively reviewed our patients with urinary tract urothelial cancer. Forty-two dialysis patients who underwent complete urinary tract exenteration were enrolled in our study. Seventeen patients had undergone one-stage complete urinary tract exenteration, and twenty-five patients had undergone multi-stage surgery. We reviewed the demographic, clinical, surgical, and pathological data to determine the clinical and pathologic variables that affected the survival between the two groups.


RESULTS
Baseline demographics were comparable in both groups. There was no significant difference in age, American Society of Anesthesiologists class, Charlson index, or body mass index between the two groups. Furthermore, there was no statistically significant difference in estimated blood loss (1280 vs. 1440 ml) or total hospital stay (31 vs. 21 days). Simultaneous upper and lower tract tumors were noted in one-stage CUTE group In comparison with multi-stage surgery, one-stage surgery was associated with a higher complication rate (58.8 vs. 28%). Twenty-two patients were still alive at the end of the study, and 20 had died. The median survival period after confirmation of complete urinary tract exenteration status was 27.5 months. The overall survival was the same between the two groups. The Charlson comorbidity index was a mandatory indicator to predict long-term survival outcome.


CONCLUSIONS
In dialysis patients with urothelial cancers who have undergone complete urinary tract exenteration, one-stage complete urinary tract exenteration had a high perioperative complication rate. The Charlson comorbidity index was a mandatory indicator to predict long-term survival outcome.
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. donou1969@yahoo.com.tw.
Chien-Hui
http://orcid.org/0000-0002-6555-0172
CH
Ou
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Wen-Horng
WH
Yang
D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015897:Comorbidity; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000601:surgery*
Cystectomy; Dialysis; Nephrectomy; Transitional cell carcinoma; Urothelial cancer