Persistent Pain After Cystectomy for Bladder Cancer
| Status: | Completed |
|---|---|
| Conditions: | Chronic Pain, Post-Surgical Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 10/6/2018 |
| Start Date: | January 2016 |
| End Date: | February 2017 |
Persistent Postsurgical Pain (PPSP) Following Cystectomy: A Survey and Sensory Examination
This single-center, cross-sectional survey and sensory examination is conducted to determine
the prevalence, sensory characteristics and risk factors of PPSP in patients who underwent
cystectomy at Washington University/Barnes-Jewish Hospital between 2009 and 2015. Based on
data from other lower abdominal surgeries, the investigators hypothesize that 10-15% of
patients undergoing cystectomy will develop PPSP.
the prevalence, sensory characteristics and risk factors of PPSP in patients who underwent
cystectomy at Washington University/Barnes-Jewish Hospital between 2009 and 2015. Based on
data from other lower abdominal surgeries, the investigators hypothesize that 10-15% of
patients undergoing cystectomy will develop PPSP.
Currently, open radical cystectomy (ORC) with urinary diversion is the standard treatment for
patient with muscle-invasive organ-confined bladder cancer. ORC involves the complete
resection of local metastatic disease and reconstruction of a functional urinary tract.
Additionally, minimally invasive laparoscopic surgery was shown to be safe alternative to
open radical cystectomy. A total of 29,719 patients underwent a form of cystectomy in the
United States between 2009 and 2011. Both cystectomy procedures require a midline incision on
the pubic symphysis, and as with virtually any surgical incision, it produces tissue injury
and inflammation, which result is acute post-operative pain.
Acute pain after surgery typically subsides with tissue healing; however, some patients go on
to develop persistent post-surgical pain (PPSP). It is estimated that 21-52% of people who
had underwent thoracotomy, 21.5-47.3% of women who had breast surgery, and 4.7%-18% of people
who had underwent abdominal surgery developed PPSP. The incidence of the condition varies
substantially by the type of surgical procedure, which is also an important factor affecting
the mechanism of PPSP. For example, while thoracic surgeries result in predominantly
neuropathic pain due to intraoperative nerve injury, in hysterectomies and knee replacement
surgeries the mechanisms of PPSP seem to be predominantly inflammatory. However, no data are
currently available on the prevalence or potential mechanisms of PPSP after cystectomy.
Understanding the prevalence, risk factors, and the potential mechanisms underlying PPSP
after cystectomy will serve the basis for investigating approaches for risk stratification
and prevention of PPSP in bladder cancer patients undergoing the procedure.
patient with muscle-invasive organ-confined bladder cancer. ORC involves the complete
resection of local metastatic disease and reconstruction of a functional urinary tract.
Additionally, minimally invasive laparoscopic surgery was shown to be safe alternative to
open radical cystectomy. A total of 29,719 patients underwent a form of cystectomy in the
United States between 2009 and 2011. Both cystectomy procedures require a midline incision on
the pubic symphysis, and as with virtually any surgical incision, it produces tissue injury
and inflammation, which result is acute post-operative pain.
Acute pain after surgery typically subsides with tissue healing; however, some patients go on
to develop persistent post-surgical pain (PPSP). It is estimated that 21-52% of people who
had underwent thoracotomy, 21.5-47.3% of women who had breast surgery, and 4.7%-18% of people
who had underwent abdominal surgery developed PPSP. The incidence of the condition varies
substantially by the type of surgical procedure, which is also an important factor affecting
the mechanism of PPSP. For example, while thoracic surgeries result in predominantly
neuropathic pain due to intraoperative nerve injury, in hysterectomies and knee replacement
surgeries the mechanisms of PPSP seem to be predominantly inflammatory. However, no data are
currently available on the prevalence or potential mechanisms of PPSP after cystectomy.
Understanding the prevalence, risk factors, and the potential mechanisms underlying PPSP
after cystectomy will serve the basis for investigating approaches for risk stratification
and prevention of PPSP in bladder cancer patients undergoing the procedure.
Inclusion Criteria:
- Age greater than or equal to 18;
- Cystectomy for bladder cancer performed at Washington University/Barnes-Jewish
Hospital between Jan 1, 2009 and June 30, 2015.
Exclusion Criteria:
Surveys will not be sent if any of the following criteria exist:
- Patient is deceased or has moved out of the United States.
- Preoperative record indicates multiple surgeries in the abdominopelvic region.
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