Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

Abstract

Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery.Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients.Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

Mortality after radical cystectomy is strongly related to the institution's volume of surgeries

“…It is known from previous studies that in-hospital mortality is two to three-fold lower than 90-day mortality. (12,22,23) The hospital length of stay varied widely in institutions with a lower number of procedures, and there was a trend towards an average of 12.6 days when considering the institutions with a larger volume of procedures (Figure 4). Therefore, even though 90-day mortality is not provided in the DATASUS database, it is expected to range between impressive 17% to 25.5%.…”

“…It is known from previous studies that in-hospital mortality is two to three-fold lower than 90-day mortality. ( 12 , 22 , 23 ) Therefore, even though 90-day mortality is not provided in the DATASUS database, it is expected to range between impressive 17% to 25.5%. Additionally, mortality rates do not seem to demonstrate any reduction trend during the last decade.…”

“…Sabe-se de estudos anteriores em que a mortalidade intra-hospitalar é duas a três vezes mais baixa que a mortalidade em 90 dias. ( 12 , 22 , 23 ) Portanto, embora a mortalidade em 90 dias não seja fornecida pelo DATASUS, espera-se que ela varie entre impressionantes 17% a 25,5%. Além disso, as taxas de mortalidade não parecem mostrar tendência de redução durante a última década.…”

High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients

“…In-hospital mortality is lower than 30-day mortality, which is two to three-fold lower than 90-day mortality. And these numbers vary widely (1,12,13).…”

The significance of preoperative estimated glomerular filtration rate on survival outcomes in patients who underwent radical cystectomy and non-continent urinary diversion

“…Radical cystectomy (RC) with extended pelvic lymph node dissection is the best choice of treatment in patients with non-metastatic muscle-invasive and high-risk non-muscle in-vasive bladder cancer (1)(2)(3)(4). The procedure is completed with urinary diversion (UD) after the removal of the bladder.…”