Perioperative and long-term outcomes after radical cystectomy in hemodialysis patients

Scott C. Johnson, Zachary L. Smith, Shay Golan, Joseph F. Rodriguez, Shane M. Pearce, Norm D. Smith, Gary D. Steinberg

Research output: Contribution to journalArticlepeer-review

4 Scopus 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.

Original languageEnglish
Pages (from-to)237.e19-237.e24
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number5
DOIs
StatePublished - May 2018

Keywords

  • Bladder cancer
  • Dialysis
  • End-stage renal disease
  • Radical cystectomy
  • Urinary diversion

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