Johnson SC, et al. - For nonmetastatic muscle–invasive bladder cancer, radical cystectomy (RC) is the standard of care. In this study, researchers investigated hemodialysis patients for perioperative and long-term outcomes after radical cystectomy. In these patients, RC was found to be associated with significant morbidity and mortality, with less than 15% overall survival at 5 years. An increased risk of mortality was evident for older patients and those with a history of diabetes or cerebrovascular disease.

Methods

• Researchers used the United States Renal Disease System database to assess all patients on hemodialysis who underwent RC for bladder cancer in the United States between 1984 and 2013.
• For analysis, they identified a total of 985 patients.
• Evaluation of perioperative outcomes was performed.
• Overall and cancer-specific mortality along with factors associated with death were assessed using competing risks analysis.

Results

• In this study, median hospital length of stay was 10 days.
• Complication was reported by 43.1% of patients .
• Thirty-day mortality of 9.3% was evident.
• At 1, 3, and 5 years, overall mortality was 51.7%, 77.3%, and 87.9%, respectively and cancer-specific mortality was 12.3%, 18.4%, and 19.7%, respectively.
• Observations suggested an independent association of age, diabetes, and cerebrovascular disease with overall mortality, while performance of urinary diversion was associated with a protective effect.
• For cancer-specific mortality, active smoking emerged as the sole risk factor.