Bladder CancerPerioperative Complications of Radical Cystectomy in a Contemporary Series
Introduction
Bladder cancer is the second most common urologic malignancy, with transitional cell carcinoma making up nearly 90% of all primary bladder tumors [1]. The general increase in life span is associated with an increase in the incidence of bladder cancer, which has significantly increased over the last 20 yr [2]. Although the majority of patients present with superficial bladder cancer, 20–40% either present with or develop invasive disease [1].
Radical cystectomy with pelvic lymph node dissection is the gold standard treatment for muscle-invasive bladder carcinoma and remains the most effective method for local control [3]. Radical cystectomy is a major procedure with the potential for serious complications, most of which develop in the early postoperative period. However, improvements in surgical technique, anesthesia, and peri- and postoperative management have reduced the complication and mortality rates previously associated with this operation.
In this study we retrospectively evaluated the perioperative morbidity and mortality in patients who underwent radical cystectomy and urinary diversion for bladder cancer in our department over a period of 12 yr. Operative time, length of postoperative hospital stay, and transfusion rates were analysed as well.
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Patients and methods
We reviewed the records of all 516 patients with advanced bladder cancer who underwent radical cystectomy and urinary diversion between April 1993 and August 2005 in our department. Patients who underwent cystectomy with pelvic exenteration for advanced bowel or gynaecologic malignancies are not included in this series. Of these 516 patients, 413 (80.0%) were male and 103 (20.0%) female. The mean patient age was 66.3 yr (median: 67 yr; range: 31–89); 64.5% of patients had a preoperative ASA
Results
Tumor stages after transurethral resection and prior to cystectomy were pT1 G3 in 13.4%, pT2 in 70.7%, pT3 in 2.0%, pT4 in 3.7%, and/or pTis in 15.2%. Pathologic stages after cystectomy were pT0 in 18.3%, pTa in 1.3%, pT1 in 10.6%, pT2 in 21.9%, pT3 in 26.4%, pT4 in 12.8%, and/or pTis in 13.4%. Lymph node metastases were found in 22.7% of all patients (pN1 in 8.5%, pN2 in 13.6%, pN3 in 0.6%). Five hundred two patients had transitional cell carcinoma, 6 adenocarcinoma, 4 squamous cell carcinoma,
Discussion
Radical cystectomy is the treatment of choice for patients with invasive bladder cancer. Although the surgical routine with this procedure has improved and even less invasive laparoscopic techniques can now be applied to radical cystectomy [4], it remains an operative procedure with significant morbidity and potentially life-threatening complications. Although the morbidity of radical cystectomy is clearly lower than in previous decades, probably because of more sophisticated postoperative care
Conclusions
Radical cystectomy represents routine surgery in patients who suffer from invasive bladder cancer. Even though cystectomy is a major procedure with a significant complication rate, our results demonstrate that radical cystectomy can be safely performed with acceptable morbidity and mortality in properly selected patients. It seems that improvements in surgical and anaesthetic technique, and increased quality of perioperative care have in recent years resulted in reduced morbidity and shorter
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