Complications in a Personal Series of One Hundred and Five Radical Cystectomies: Specific Problems in a Developing Country

Srinivas, V.; Nagapurkar, N.; Choudary, R.; Alvani, A.; Mehta, Hemalkumar B.; Phadke, A.G.

doi:10.1159/000282595

Cited by 3 publications

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“…Radical cystectomy and PLND has become the principal therapeutic treatment for muscle‐invasive bladder cancer. In most large series the perioperative mortality rate from radical cystectomy is 2–5%, the reoperation rate 2–10% and the complication rate 25–35% [2–4]. In the present series the complication rate was 27.6%.…”

Section: Discussionmentioning

confidence: 47%

“…Radical cystectomy with pelvic lymph node dissection (PLND) is the standard treatment for muscle‐invasive bladder cancer, a procedure popularized initially by Whitmore and Marshall [1]. The advent of improved surgical techniques, anaesthesia care and postoperative management has lowered the high complication and mortality rates previously associated with this operation [2–4]. Unrecognized distant metastases resulting in decreased survival occur in almost half of patients with high‐grade tumours who undergo cystectomy [2,5].…”

Section: Introductionmentioning

confidence: 99%

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Retrospective review and long‐term follow‐up of radical cystectomy in a developing country

et al. 2002

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Objective To retrospectively review the clinical data from patients undergoing radical cystectomy for bladder cancer, and to analyse the complications and survival rates associated with this operation in a developing country. Patients and methods The study comprised 105 patients who underwent radical cystectomy from 1986 to 1993. Data were collected from retrospective reviews of hospital and physician's of®ce records, and by contact with the patients. Metastatic status was evaluated before surgery and tumours staged using the TumourNodes-Metastasis classi®cation. The indication for surgery was histologically con®rmed muscle invasion after transurethral resection biopsy, or endoscopically uncontrollable super®cial disease. The data were analysed to assess the perioperative complications and long-term survival, with 5-year survival rates determined using Kaplan±Meier survival curves. Results The complication rate was 27.6%; most of the complications were managed conservatively with good results and re-operation was required in only two patients. There were two deaths (1.9%) at 15±45 days after surgery, but none during surgery. Patients were divided into node-negative and node-positive groups for analysis and 5-year survival rates determined; for node-negative organ-con®ned disease (fpT3A) the survival was 68% and for nonorgan-con®ned disease (opT3B) 25%. The 5-year survival rate in the presence of nodal metastases was 13% for N1 and none for N2 disease. Six patients developed urethral recurrence, detected on follow-up urethral-wash cytology. Five of these patients underwent urethrectomy, and four of the six survived for 5 years. Pelvic recurrence occurred in ®ve patients (4.7%), none of whom survived for 5 years. Conclusion Radical cystectomy and pelvic lymph node dissection remains the mainstay of treatment in muscle-invasive bladder cancer. This is a relatively safe procedure with minimal morbidity and mortality; 68% of the present patients with organ-con®ned disease survived 5 years and 12 patients were alive at 10 years, indicating the effectiveness of this operation in selected cases. However, <29% of patients with nonorgan-con®ned and nodal metastatic disease survived 5 years, thereby implying the need for more effective adjuvant therapy in these patients. Radical cystectomy is a viable option in developing countries, with 5-year survival rates comparable with most large published series.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%