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      Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer : A Randomized Clinical Trial

      1 , 2 , 3 , 3 , 4 , 5 , 6 , 3 , 7 , 7 , 7 , 3 , 8 , 3 , 3 , 3 , 9 , 9 , 10 , 10 , 1 , 2 , 1 , 11 , 12 , 13 , 14 , 2 , 13 , 15 , 16 , 5 , 5 , 3 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , iROC Study Team
      JAMA
      American Medical Association (AMA)

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          The Clavien-Dindo classification of surgical complications: five-year experience.

          The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible, flexible, and applicable irrespective of the cultural background. The aim of the current study was to critically evaluate this classification from the perspective of its use in the literature, by assessing interobserver variability in grading complex complication scenarios and to correlate the classification grades with patients', nurses', and doctors' perception. Reports from the literature using the classification system were systematically analyzed. Next, 11 scenarios illustrating difficult cases were prepared to develop a consensus on how to rank the various complications. Third, 7 centers from different continents, having routinely used the classification, independently assessed the 11 scenarios. An agreement analysis was performed to test the accuracy and reliability of the classification. Finally, the perception of the severity was tested in patients, nurses, and physicians by presenting 30 scenarios, each illustrating a specific grade of complication. We noted a dramatic increase in the use of the classification in many fields of surgery. About half of the studies used the contracted form, whereas the rest used the full range of grading. Two-thirds of the publications avoided subjective terms such as minor or major complications. The study of 11 difficult cases among various centers revealed a high degree of agreement in identifying and ranking complications (89% agreement), and enabled a better definition of unclear situations. Each grade of complications significantly correlated with the perception by patients, nurses, and physicians (P < 0.05, Kruskal-Wallis test). This 5-year evaluation provides strong evidence that the classification is valid and applicable worldwide in many fields of surgery. No modification in the general principle of classification is warranted in view of the use in ongoing publications and trials. Subjective, inaccurate, or confusing terms such as "minor or major" should be removed from the surgical literature.
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            The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology

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              European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines

              This overview presents the updated European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC).
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                Author and article information

                Journal
                JAMA
                JAMA
                American Medical Association (AMA)
                0098-7484
                June 07 2022
                June 07 2022
                : 327
                : 21
                : 2092
                Affiliations
                [1 ]Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
                [2 ]Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
                [3 ]Division of Surgery and Interventional Science, University College London, London, England
                [4 ]Owlstone Medical, Cambridge, England
                [5 ]Department of Statistical Science, University College London, London, England
                [6 ]Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, England
                [7 ]Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
                [8 ]Health Economics and Decision Science, NIHR Research Design Service Yorkshire and the Humber, University of Sheffield, Sheffield, England
                [9 ]Queen Elizabeth University Hospital, Glasgow, Scotland
                [10 ]The Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, England
                [11 ]Department of Medical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
                [12 ]Pyrah Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, England
                [13 ]Department of Urology, North Bristol NHS Trust, Bristol, England
                [14 ]Department of Urology, Royal Devon University Hospitals Foundation Trust and University of Exeter, Exeter, England
                [15 ]Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, University of Hertfordshire, Hatfield, England
                [16 ]Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, England
                [17 ]for the iROC Study Team
                Article
                10.1001/jama.2022.7393
                35569079
                85604f0a-15e1-478c-90f4-3d3640c88926
                © 2022
                History

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