Letter to the Editor regarding the Article “Postoperative Mortality Rate after Radical Cystectomy: A Systematic Review of Epidemiologic Series”
Notice bibliographique
Résumé
Dear Editor,We have read an article recently published by Korkes and associates with great interest [1]. This interesting systematic review makes us question different aspects of radical and reconstructive surgery of muscle-invasive bladder cancer. The emphasis of the article is on the mortality rate after cystectomy. As expected, it resulted in mortality rates that are significantly lower in countries with major developed economies than in developing countries. Mortality rates are also lower in high-volume centers than those in low-volume centers.Interestingly, Canada simultaneously had the lowest rate of in-hospital mortality and the highest rate of 90-day mortality (90M). Korkes et al. did not offer a possible explanation for these results. The answer could be the importance of the availability of a center experienced in managing complications. Another topic from this article that deserves attention is the proportion of patients treated with cystectomy among patients who have an absolute indication for this type of surgery. If we know that radical surgical treatment is “the gold standard” for patients with pT2–pT4 M0 disease, the percentage of 18.9% of the patients treated with radical surgery is extremely low [2]. An alternative to operative treatment is trimodal treatment, which according to the guidelines is reserved for small, solitary tumors or patients with contraindications for surgery [3]. We are well aware that both of these groups of patients make up a minor part of the total number of candidates for radical treatment. The third question from this article is the choice of urinary diversion. It was shown that only 10.4% of patients receive continent diversion, which is similar to the results of Hautmann and associates from 2015, where the percentage in institutions worldwide is 15%, it reaches 30–45% in leading oncology centers, and only in pioneering institutions amounts to about 75% [4].Given that our Department of Urology performs about 100 cystectomies per year, of which 40–50% are with orthotopic derivation, the above questions are extremely interesting to us. We believe there is a unique answer to all three open questions. The centralization of patients in high-volume centers brings with it (1) a lower mortality rate, as stated in this article; (2) an adequate form of treatment considering the significantly higher percentage of patients treated with radical cystectomy; (3) the most appropriate form of urinary diversion.All the authors declare no conflict of interests.This work has not received any funding.Pero Bokarica, Masa Alfirevic, Adelina Hrkac, Ana Magdalena Glas, and Igor Tomaskovic participated in the writing of the manuscript. Pero Bokarica, Masa Alfirevic, and Adelina Hrkac did the concept and design of the manuscript.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».