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Id: biblio-1142877
Autor: Korkes, Fernando; Cunha, Frederico Timóteo Silva; Nascimento, Matheus Prado; Rodrigues, Antonio Flávio Silva; Baccaglini, Willy; Glina, Sidney.
Título: Mortality after radical cystectomy is strongly related to the institution's volume of surgeries / Mortalidade pós-cistectomia radical está fortemente associada ao volume de cirurgias da instituição
Fonte: Einstein (Säo Paulo);18:eAO5628, 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.

RESUMO Objetivo: Analisar as taxas de mortalidade e os dados de hospitalização após cistectomia radical em cada unidade pública de saúde de São Paulo na última década, levando em conta o número de cirurgias realizadas por unidade. Métodos: Este estudo incluiu pacientes do Departamento de Informática do Sistema Único de Saúde de São Paulo submetidos à cistectomia radical entre 2008 e 2018. Os dados analisados incluíram o nome da instituição, o número de procedimentos/ano, taxas de mortalidade hospitalar e tempo de internação hospitalar. Resultados: Foram registrados 1.377 cistectomias radicais no sistema público de saúde de São Paulo no período. Um total de 91 instituições realizou pelo menos uma cirurgia na década analisada. O número de cistectomias realizadas por instituição durante os anos analisados variou de uma a 161. Apenas 45,6% dos pacientes foram operados em instituições com volume cirúrgico maior do que cinco cistectomias radicais/ano. Ao todo, 684 pacientes foram operados em instituições com maior volume cirúrgico. Houve 117 óbitos hospitalares, representando taxa de mortalidade de 8,5% para o estado de São Paulo na última década. Enquanto instituições com o maior volume (seis cistectomias radicais/ano) apresentaram mortalidade de 6,1%, as instituições com menor volume (<1 cistectomia radical/ano) apresentaram taxa de mortalidade de 17,5%. Conclusão: Houve forte relação entre o volume institucional de cistectomia radical e a taxa de mortalidade hospitalar após cistectomia radical em São Paulo, no período de 2008 a 2018. Infelizmente, não se observa no Brasil tendência de centralização de procedimentos complexos, como tem ocorrido em países desenvolvidos nas últimas décadas.
Descritores: Cistectomia
-Neoplasias da Bexiga Urinária/cirurgia
Mortalidade Hospitalar
Hospitalização
Limites: Humanos
Responsável: BR1.1 - BIREME


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Id: biblio-1153179
Autor: Tosatto, Valentina; Pimentel, João Cabral; Cruz, Cristiano; Almeida, André; Boattini, Matteo.
Título: Acute liver failure due to radiographically occult infiltration of urothelial cancer
Fonte: Autops. Case Rep;11:e2021256, 2021. tab, graf.
Idioma: en.
Resumo: Introduction Acute liver failure (ALF) due to diffuse infiltrating solid malignancy without any focal lesions on radiographic imaging is rare. Case report A 70-year-old man was admitted due to mental confusion, abdominal pain, and ALF. Three years before, he had undergone a left nephrectomy for urothelial carcinoma followed by adjuvant chemotherapy. The abdominal computed tomography (CT) showed hepatomegaly and ascites. Ascitic fluid had transudate characteristics, with no malignant cells. Percutaneous liver biopsy (LB) showed diffuse liver infiltration of metastatic urothelial carcinoma. The patient rapidly deteriorated and died in a week due to ALF. Discussion History of solid cancer and hepatomegaly and/or liver failure without other obvious explanation should encourage to perform LB. Conclusion LB is warranted to avoid misdiagnosis, prolonged hospital stays, and delay in palliative care.
Descritores: Neoplasias da Bexiga Urinária/patologia
Carcinoma
Falência Hepática Aguda/patologia
-Ascite
Autopsia
Biópsia
Evolução Fatal
Erros de Diagnóstico
Hepatomegalia
Limites: Humanos
Masculino
Idoso
Tipo de Publ: Relatos de Casos
Conferência Clínica
Responsável: BR26.7 - Serviço de Biblioteca e Documentação Científica


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Id: biblio-1249023
Autor: Benerjee, Nirmalya; Parmar, Kalpesh; Vaiphei, Kim.
Título: Primary signet-ring cell carcinoma of the urinary bladder
Fonte: Autops. Case Rep;11:e2021264, 2021. tab, graf.
Idioma: en.
Resumo: Primary signet-ring cell carcinoma of the urinary bladder is a rare tumor. The overall incidence is approximately 0.12-0.6% of all urinary bladder malignancies. The majority of the patients present in an advanced stage with a uniformly grim prognosis. As signet-ring cell carcinomas are more common in the gastrointestinal tract, a possibility of metastasis needs to be considered. Here we report, a 42-year-old patient who presented with hematuria and was diagnosed with a urinary bladder tumor. The patient was managed with partial cystectomy and pelvic lymph node dissection. The histopathological examination confirmed primary signet-ring cell carcinoma of the urinary bladder.
Descritores: Neoplasias da Bexiga Urinária/patologia
Carcinoma de Células em Anel de Sinete/patologia
-Cistectomia
Limites: Humanos
Masculino
Adulto
Tipo de Publ: Relatos de Casos
Responsável: BR26.7 - Serviço de Biblioteca e Documentação Científica


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Id: lil-796874
Autor: Dias, Queila Cristina; Nunes, Iseu da Silva; Garcia, Patrick Vianna; Fávaro, Wagner José.
Título: Potential therapeutic strategies for non - muscle invasive bladder cancer based on association of intravesical immunotherapy with P-MAPA and systemic administration of cisplatin and doxorubicin
Fonte: Int. braz. j. urol;42(5):942-954, Sept.-Oct. 2016. tab, graf.
Idioma: en.
Projeto: CNPq-Brazil; . FAPESP-Brazil.
Resumo: ABSTRACT The present study describes the histopathological and molecular effects of P-MAPA (Protein aggregate magnesium-ammonium phospholinoleate-palmitoleate anhydride) intravesical immunotherapy combined with systemic doxorubicin or cisplatin for treatment of non-muscle invasive bladder cancer (NMIBC) in an appropriate animal model. Our results showed an undifferentiated tumor, characterizing a tumor invading mucosa or submucosa of the bladder wall (pT1) and papillary carcinoma in situ (pTa) in the Cancer group. The histopathological changes were similar between the combined treatment with intravesical P-MAPA plus systemic Cisplatin and P-MAPA immunotherapy alone, showing decrease of urothelial neoplastic lesions progression and histopathological recovery in 80% of the animals. The animals treated systemically with cisplatin or doxorubicin singly, showed 100% of malignant lesions in the urinary bladder. Furthemore, the combined treatment with P-MAPA and Doxorubicin showed no decrease of urothelial neoplastic lesions progression and histopathological recovery. Furthermore, Akt, PI3K, NF-kB and VEGF protein levels were significantly lower in intravesical P-MAPA plus systemic cisplatin and in intravesical P-MAPA alone treatments than other groups. In contrast, PTEN protein levels were significantly higher in intravesical P-MAPA plus systemic cisplatin and in intravesical P-MAPA alone treatments. Thus, it could be concluded that combination of intravesical P-MAPA immunotherapy and systemic cisplatin in the NMIBC animal model was effective, well tolerated and showed no apparent signs of antagonism between the drugs. In addition, intravesical P-MAPA immunotherapy may be considered as a valuable option for treatment of BCG unresponsive patients that unmet the criteria for early cystectomy.
Descritores: Neoplasias da Bexiga Urinária/terapia
Carcinoma/terapia
Doxorrubicina/uso terapêutico
Cisplatino/uso terapêutico
Imunoterapia/métodos
Proteínas de Membrana/uso terapêutico
Antineoplásicos/uso terapêutico
-Ratos Endogâmicos F344
Neoplasias da Bexiga Urinária/patologia
Administração Intravesical
Vacina BCG
Carcinoma/patologia
Western Blotting
Reprodutibilidade dos Testes
NF-kappa B/análise
Resultado do Tratamento
Terapia Combinada
Progressão da Doença
Fosfatidilinositol 3-Quinases/análise
Modelos Animais
Fator A de Crescimento do Endotélio Vascular/análise
PTEN Fosfo-Hidrolase/análise
Proteínas Proto-Oncogênicas c-akt/análise
Limites: Animais
Feminino
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: lil-796883
Autor: Almeida, Gilberto L; Busato J, Wilson F. S; Ribas, Carmen Marcondes; Ribas-Filho, Jurandir Marcondes; De Cobelli, Ottavio.
Título: External validation of EORTC risk scores to predict recurrence after transurethral resection of brazilian patients with non-muscle invasive bladder cancer stages Ta and T1
Fonte: Int. braz. j. urol;42(5):932-941, Sept.-Oct. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Validate the EORTC risk tables in Brazilian patients with NMIBC. Methods: 205 patients were analyzed. The 6 parameters analyzed were: histologic grading, pathologic stage, size and number of tumors, previous recurrence rate and concomitant CIS. The time for first recurrence (TFR), risk score and probability of recurrence were calculated and compared to the probabilities obtained from EORTC risk tables. C-index was calculated and accuracy of EORTC tables was analyzed. Results: pTa was presented in 91 (44.4%) patients and pT1 in 114 (55.6%). Ninety-seven (47.3%) patients had solitary tumor, and 108 (52.7%) multiple tumors. One hundred and three (50.2%) patients had tumors smaller than 3 cm and 102 (40.8%) had bigger than 3 cm. Concomitant CIS was observed in 21 (10.2%) patients. Low grade was presented in 95 (46.3%) patients, and high grade in 110 (53.7%). Intravesical therapy was utilized in 105 (56.1%) patients. Recurrence was observed in 117 (57.1%) patients and the mean TFR was 14,2 ± 7,3 months. C-index was 0,72 for 1 year and 0,7 for 5 years. The recurrence risk was 28,8% in 1 year and 57,1% in 5 years, independently of the scoring risk. In our population, the EORTC risk tables overestimated the risk of recurrence in 1 year and underestimated in 5 years. Conclusion: The validation of the EORTC risk tables in Brazilian patients with NMIBC was satisfactory and should be stimulated to predict recurrence, although these may overestimated the risk of recurrence in 1 year and underestimated in 5 years.
Descritores: Neoplasias da Bexiga Urinária/cirurgia
Neoplasias da Bexiga Urinária/patologia
Medição de Risco/métodos
Recidiva Local de Neoplasia/patologia
-Fatores de Tempo
Brasil
Valor Preditivo dos Testes
Estudos Prospectivos
Reprodutibilidade dos Testes
Fatores de Risco
Progressão da Doença
Gradação de Tumores
Pessoa de Meia-Idade
Invasividade Neoplásica
Estadiamento de Neoplasias
Limites: Humanos
Masculino
Feminino
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo de Validação
Responsável: BR1.1 - BIREME


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Id: lil-794682
Autor: Favilla, Vincenzo; Castelli, Tommaso; Urzì, Daniele; Reale, Giulio; Privitera, Salvatore; Salici, Antonio; Russo, Giorgio Ivan; Cimino, Sebastiano; Morgia, Giuseppe.
Título: Neutrophil to lymphocyte ratio, a biomarker in non-muscle invasive bladder cancer: a single-institutional longitudinal study
Fonte: Int. braz. j. urol;42(4):685-693, July-Aug. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Background: Bladder cancer represents one of the most important clinical challenges in urologic practice. In this context, inflammation has an important role in the development and progression of many malignancies. The objective of the present study was to evaluate the prognostic value of pre-treatment Neutrophil to lymphocyte ratio (NLR) on the risk of recurrence and progression in patients with primary non-muscle invasive bladder cancer. Materials and Methods: Data obtained from 178 bladder cancer patients who underwent transurethral resection of bladder tumor (TURB) between July 2008 and December 2014 were evaluated prospectively. NLR was obtained from each patient before TURB and defined as the absolute neutrophil count divided by the absolute lymphocyte count. Cox proportional hazards regression model was performed to calculate disease recurrence and progression including NLR. Results: During the follow-up study (median: 53 months), 14 (23.3%) and 44 (37.9%) (p=0.04) patients respectively with NLR<3 and ≥3experienced recurrence and 2 (3.3%) and 14 (11.9%) experienced progression (p=0.06), respectively. At the multivariate Cox regression analysis, NLR ≥3 was associated with worse disease recurrence (HR: 2.84; p<0.01). No association was found regarding disease progression. The 5-year recurrence free survival was 49% and 62% in patients with NLR≥3 and <3 (p<0.01). The 5-year progression free survival was 77% and 93% in patients with NLR≥3 and <3 (p=0.69). Conclusion: NLR predicts disease recurrence but not disease progression in NMIBC patients. NLR alterations may depend of tumor inflammatory microenvironment.
Descritores: Neoplasias da Bexiga Urinária/sangue
Linfócitos
Biomarcadores Tumorais/sangue
Neutrófilos
-Prognóstico
Neoplasias da Bexiga Urinária/mortalidade
Neoplasias da Bexiga Urinária/patologia
Contagem de Células Sanguíneas
Análise de Sobrevida
Seguimentos
Contagem de Linfócitos
Intervalo Livre de Doença
Itália/epidemiologia
Contagem de Leucócitos
Invasividade Neoplásica
Limites: Humanos
Masculino
Feminino
Idoso
Responsável: BR1.1 - BIREME


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Id: lil-794684
Autor: Cusano, Antonio; Haddock, Peter; Jackson, Max; Staff, Ilene; Wagner, Joseph; Meraney, Anoop.
Título: A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy
Fonte: Int. braz. j. urol;42(4):663-670, July-Aug. 2016. tab.
Idioma: en.
Resumo: ABSTRACT Purpose: To compare complications and outcomes in patients undergoing either open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RRC). Materials and Methods: We retrospectively identified patients that underwent ORC or RRC between 2003- 2013. We statistically compared preliminary oncologic outcomes of patients for each surgical modality. Results: 92 (43.2%) and 121 (56.8%) patients underwent ORC and RRC, respectively. While operative time was shorter for ORC patients (403 vs. 508 min; p<0.001), surgical blood loss and transfusion rates were significantly lower in RRC patients (p<0.001 and 0.006). Length of stay was not different between groups (p=0.221). There was no difference in the proportion of lymph node-positive patients between groups. However, RRC patients had a greater number of lymph nodes removed during surgery (18 vs. 11.5; p<0.001). There was no significant difference in the incidence of pre-existing comorbidities or in the Clavien distribution of complications between groups. ORC and RRC patients were followed for a median of 1.38 (0.55-2.7) and 1.40 (0.582.59) years, respectively (p=0.850). During this period, a lower proportion (22.3%) of RRC patients experienced disease recurrence vs. ORC patients (34.8%). However, there was no significant difference in time to recurrence between groups. While ORC was associated with a higher all-cause mortality rate (p=0.049), there was no significant difference in disease-free survival time between groups. Conclusions: ORC and RRC patients experience postoperative complications of similar rates and severity. However, RRC may offer indirect benefits via reduced surgical blood loss and need for transfusion.
Descritores: Complicações Pós-Operatórias/epidemiologia
Neoplasias da Bexiga Urinária/cirurgia
Cistectomia/estatística & dados numéricos
Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
-Estados Unidos/epidemiologia
Neoplasias da Bexiga Urinária/patologia
Transfusão de Sangue
Comorbidade
Cistectomia/efeitos adversos
Cistectomia/mortalidade
Cistectomia/normas
Incidência
Estudos Retrospectivos
Perda Sanguínea Cirúrgica
Intervalo Livre de Doença
Duração da Cirurgia
Procedimentos Cirúrgicos Robóticos/efeitos adversos
Procedimentos Cirúrgicos Robóticos/mortalidade
Procedimentos Cirúrgicos Robóticos/normas
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Feminino
Idoso
Responsável: BR1.1 - BIREME


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Id: lil-794669
Autor: Zhu, Yong-tong; Pang, Shi-yu; Luo, Yang; Chen, Wei; Bao, Ji-ming; Tan, Wan-long.
Título: A modified method by differential adhesion for enrichment of bladder cancer stem cells
Fonte: Int. braz. j. urol;42(4):817-824, July-Aug. 2016. tab, graf.
Idioma: en.
Projeto: Education Department in Guangdong Province; . Southern Medical University.
Resumo: ABSTRACT Purpose: In a previous study the vaccine was effective against bladder cancer in a mouse model. However, a small portion of tumors regrew because the vaccine could not eliminate bladder cancer stem cells (CSCs). In this study, we showed a modified method for the isolation of bladder CSCs using a combination of differential adhesion method and serum-free culture medium (SFM) method. Materials and Methods: Trypsin-resistant cells and trypsin-sensitive cells were isolated from MB49, EJ and 5637 cells by a combination of differential adhesion method and SFM method. The CSCs characterizations of trypsin-resistant cells were verified by the flow cytometry, the western blotting, the quantitative polymerase chain reaction, the resistance to chemotherapy assay, the transwell assay, and the tumor xenograft formation assay. Results: Trypsin-resistant cells were isolated and identified in CSCs characters, with high expression of CSCs markers, higher resistance to chemotherapy, greater migration in vitro, and stronger tumorigenicity in vivo. Conclusion: Trypsin-resistant cells displayed specific CSCs properties. Our study showed trypsin-resistant cells were isolated successfully with a modified method using a combination of differential adhesion method and SFM method.
Descritores: Células-Tronco Neoplásicas/citologia
Neoplasias da Bexiga Urinária/patologia
Tripsina/farmacologia
Adesão Celular/efeitos dos fármacos
Separação Celular/métodos
Técnicas de Cultura de Células/métodos
-Células-Tronco Neoplásicas/química
Biomarcadores Tumorais
Diferenciação Celular
Meios de Cultura Livres de Soro
Vacinas Anticâncer/imunologia
Linhagem Celular Tumoral
Reação em Cadeia da Polimerase em Tempo Real
Citometria de Fluxo
Camundongos Nus
Limites: Animais
Camundongos
Responsável: BR1.1 - BIREME


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Id: lil-794668
Autor: Feng, Lang; Song, Jian; Wu, Menghua; Tian, Ye; Zhang, Daoxin.
Título: Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience
Fonte: Int. braz. j. urol;42(4):655-662, July-Aug. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.
Descritores: Neoplasias da Bexiga Urinária/cirurgia
Cistectomia/métodos
Laparoscopia/métodos
-Complicações Pós-Operatórias
Derivação Urinária/métodos
Neoplasias da Bexiga Urinária/patologia
Fotografação
Estudos Retrospectivos
Seguimentos
Resultado do Tratamento
Gradação de Tumores
Duração da Cirurgia
Excisão de Linfonodo
Estadiamento de Neoplasias
Limites: Humanos
Masculino
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME


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Id: lil-785717
Autor: Corradi, Renato B; Galvão, Gustavo Jaime Climaco; Oliveira, Gabriel M; Carneiro, Vinicius F; Miconi, Wadson Gomes; Salles, Paulo Guilherme Oliveira; Cabral, Walter Luiz Ribeiro; Corradi, Carlos; Salazar, Andre Lopes Lopes.
Título: Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort
Fonte: Int. braz. j. urol;42(3):431-437tab.
Idioma: en.
Resumo: ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.
Descritores: Neoplasias da Bexiga Urinária/cirurgia
Neoplasias da Bexiga Urinária/patologia
Carcinoma de Células Escamosas/cirurgia
Carcinoma de Células Escamosas/patologia
Carcinoma de Células de Transição/cirurgia
Carcinoma de Células de Transição/patologia
Cistectomia/métodos
Excisão de Linfonodo/métodos
-Pelve
Complicações Pós-Operatórias
Prognóstico
Fatores de Tempo
Biópsia
Neoplasias da Bexiga Urinária/complicações
Brasil
Carcinoma de Células Escamosas/complicações
Carcinoma de Células de Transição/complicações
Adenocarcinoma/cirurgia
Adenocarcinoma/complicações
Adenocarcinoma/patologia
Cistectomia/efeitos adversos
Estudos Retrospectivos
Duração da Cirurgia
Excisão de Linfonodo/efeitos adversos
Linfonodos/cirurgia
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Feminino
Adulto
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME



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