Page 2 - CUA2019 Abstracts - Oncology-Bladder

Poster session 2: bladder Cancer

MP-2.3 efficacy of the SSI reduction strategy and characterize risk factors for SSI.
Predicting complications following radical cystectomy with Methods: A historical cohort of all patients who underwent RC by four
the National Surgical Quality Improvement Program universal urologic oncologists at The Ottawa Hospital (TOH) from January 2016 to
surgical risk calculator October 2018 was reviewed. Patient, tumour, and operative characteris-
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Miles Mannas , Taeweon Lee , Tracey Hong , Andrea Bisaillon , Alan I. tics were collected. Inpatient and outpatient SSIs were identified until 30
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So , Martin E. Gleave , Kelly Mayson , Peter C. Black 1,2 days postoperative from the medical record. The SSI reduction strategy
1 Urologic Sciences, University of British Columbia, Vancouver, BC, was implemented for all patients having RC after February 28, 2018.
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Canada; Vancouver Prostate Centre, Vancouver, BC, Canada; Quality Adjusted associations between patient, tumour, operative characteristics,
and Patient Safety Coordinator, Vancouver General Hospital, Vancouver, and the SSI reduction intervention with the risk of SSI was determined.
BC, Canada; Anesthesia and Perioperative Care, Vancouver General Results: A total of 117 patients underwent RC during the study period,
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Hospital, Vancouver, BC, Canada including 26 after institutional implementation of the SSI reduction strat-
Introduction: There has been debate regarding the utility of universal egy. The mean age was 70 years, 88 (75%) were male, and 51 (44%)
surgical risk calculators, such as that developed by the National Surgical received neobladders. Higher body mass index, history of smoking,
Quality Improvement Program (NSQIP), to aid in point-of-care predic- intraoperative transfusion, and diabetes were independently associated
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tion of complications in individual patients preoperatively. At our tertiary with increased risk of SSI (p<0.05). Overall SSI risk was 24%. The risk of
care hospital, we retrospectively evaluated the predictive value of the SSI was 28% prior to the intervention and 12% after. The SSI reduction
NSQIP universal surgical risk calculators (USRC) in a prospective cohort strategy reduced the risk of SSI by 60% (relative risk 0.42; 95% confidence
of patients who underwent radical cystectomy (RC). interval 0.14–1.28; p=0.12)
Methods: A prospective cohort of patients undergoing RC was retrospec- Conclusions: The risk of SSI after radical cystectomy is high. The imple-
tively reviewed between October 2014 and August 2017. All patients who mentation of our SSI reduction strategy reduced the risk of SSI, warranting
underwent RC for benign disease, had inadequate followup, or under- further evaluation in other centres to improve patient care.
went additional surgical procedures deemed a significant deviation from
USRC codes 51590, 51595, and 51596 were excluded (n=29). A total of MP-2.5
223 patients were included who underwent open or robotic RC (n=17). Expression status and prognostic significance of tissue and serum
Accuracy of the USRC was assessed by ROC AUC and Brier scores for micro RNAs in urothelial carcinoma of urinary bladder
NSQIP-defined complications. We also compared its prediction of any Uttam Mete , Anuradha Chakraborti , Nandita Kakkar 3
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and serious complications according to NSQIP definitions to observed 1 Urology, PGIMER, Chandigarh, Chandigarh, India; Experimental
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complications according to the Clavien-Dindo classification (any [grades Medicine, PGIMER, Chandigarh, Chandigarh, India; Pathology, PGIMER,
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1–5] and serious [grade 3–5]). Chandigarh, Chandigarh, India
Results: The USRC was found to have positive predictive ability for sev- Introduction: Clinical and pathological factors, including tumour grade
eral NSQIP complications. Determined by AUC C-stat and Brier scores, and tumour stage, are not specific enough to predict progression and
prediction was good for cardiac complications (0.80 and 0.021); fair for recurrence of bladder tumour. Patient followup is both expensive and
pneumonia (0.75 and 0.017); and poor for urinary tract infection (0.64 unpleasant (frequent invasive cystoscopies). Therefore, there is a need
and 0.078), 30-day mortality (0.62 and 0.013), any complication (0.60 for additional clinical tools, including microRNAs. The current study
and 0.19), and serious complication (0.60 and 0.17). There was signifi- was conducted to evaluate whether tissue and serum microRNAs can be
cant discordance between the rate of NSQIP predicted vs.Clavien-Dindo used as prognosticating biomarkers.
observed any and serious complications: 28.8% vs 67.3%, and 25.3% Methods: Blood and tissue samples were collected from 50 patients
vs 11.7%, respectively. AUC ROC and Brier scores indicated failure of and 10 healthy controls. miR-125, miR-31, miR-145, and miR-200 were
any and serious NSQIP-defined complication to predict for both any and assayed in both serum and tissue samples. Circulating miRNAs were
serious Clavien-Dindo-defined complications. isolated from the serum using miRNA assay serum/plasma kit, Qaigen.
Conclusions: This is the first description of the USRC indicating it may Polyadenylation and cDNA synthesis was performed using miRNA first-
have predictive power for some NSQIP-defined surgical complications strand cDNA synthesis kit, Agilent. Further, qRTPCR was performed for
after RC. the above-mentioned miRNAs.
Reference Results: Eight patients had recurrent and 42 had first-time presentation.
1. Winoker J, Paulucci, D, Anastos H, et al. Predicting complications T2 high-grade, Ta low-grade, and Ta high-grade lesions were present
following robot-assisted partial nephrectomy with the ACS NSQIP in 8, 20, and one patient(s), respectively. Twenty-one patients had T1
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universal surgical risk calculator. J Urol 2017;198:803-9. https://doi. lesion, including 13 high-grade and eight low-grade. Expression of serum
org/10.1016/j.juro.2017.04.021 miR-125 was found to be highly up-regulated in most patients, while all
other miRNAs were down-regulated. Moreover, the amount of down-
MP-2.4 regulation was higher in cases of miR-31. Tissue miRNA expression in
Reducing surgical site infections in patients undergoing radical 14 patients miR-31 was up-regulated; out of these, five had T1 high-grade
cystectomy using wound protection lesion and another four had muscle-invasive disease. Only one had Ta
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James Ross , Christopher Knee , Kristen McAlpine , Rodney H. Breau , low-grade lesion. miR-125 was very high among 36 patients and almost
Neal E. Rowe , Ilias Cagiannos , Christopher Morash , Lara Williams , all of these patients had low-grade pathology. miR-145 and mir-200 were
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Ranjeeta Mallick , Carl van Walraven 2,4,5 , Luke T. Lavallee 1,2,4 up-regulated in almost all patients.
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1 Department of Surgery, Division of Urology, University of Ottawa, Conclusions: Tissue mir-31 is usually up-regulated in high-grade or high-
Ottawa, ON, Canada; The Ottawa Hospital Research Institute, The stage lesions. Up-regulation of tissue miR-145 and miR-200 was noticed in
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Ottawa Hospital, Ottawa, ON, Canada; Department of Surgery, Division almost all patients. Therefore, we believe combined histopathology and
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of General Surgery, University of Ottawa, Ottawa, ON, Canada; School serum and tissue microRNA status can be a better prognostic factor than
of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, histopathology alone.
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Canada; Institute for Clinical Evaluative Sciences, University of Ottawa,
Ottawa, ON, Canada
Introduction: Our institution implemented a surgical site infection
(SSI) reduction strategy for patients undergoing radical cystectomy
(RC). The intervention included the use of a barrier wound protector
(Alexis retractor), sterile closing tray, wound cleansing, and antibiotic-
impregnated dressings. The objective of this study was to evaluate the
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S89