Elsevier

European Urology

Volume 51, Issue 2, February 2007, Pages 397-402
European Urology

Bladder Cancer
Perioperative Complications of Radical Cystectomy in a Contemporary Series

https://doi.org/10.1016/j.eururo.2006.06.014Get rights and content

Abstract

Objectives

Radical cystectomy is the preferred standard treatment for patients with muscle-invasive bladder cancer. With improvements in intra- and perioperative care lower complication rates have been reported. We retrospectively evaluated our series of patients who underwent radical cystectomy for advanced bladder cancer for perioperative complications as well as operative time, postoperative hospital stay and transfusion rates.

Patients and methods

Between April 1993 and August 2005, 516 radical cystectomies were performed for muscle infiltrating transitional cell carcinoma and other types of neoplastic diseases of the bladder at our institution. The average age was 66.3 yr (31–89).

Results

The perioperative mortality rate was 0.8%. A total of 141 patients (27.3%) developed at least one perioperative complication. The most frequent medical complications were subileus in 20 (3.9%) patients, deep venous thrombosis in 24 (4.7%), and enterocolitis in 10 (1.9%). Surgical complications included pelvic lymphoceles in 42 (8.1%) patients, wound dehiscence in 46 (8.9%), pelvic hematoma in 4 (0.8%), peritonitis in 4 (0.8%) and small bowel obstruction in 4 (0.8%). The total early reoperation rate was 6.2%. Operative time, postoperative hospital stay and average number of blood units transfused decreased over the period 1993–2005.

Conclusions

Radical cystectomy today is a procedure with an acceptable rate of perioperative morbidity and mortality. Improvements in surgical technique and anaesthesia as well as increased quality of perioperative care in recent years have resulted in reduced morbidity and shorter hospital stay.

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.

Section snippets

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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