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

Abstract

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.

Complications of radical cystectomy for bladder cancer

“…Recurrence rate in present study was 14.28% which was higher compared to Gaitonde KA et al, with recurrence rate of 4.7%. 29 However, the pattern of recurrence in present study was similar to Koh DM et al, with pelvic recurrence being most common, seen in 66.66% and 55% respectively. 30 The incidence of loco-regional recurrence in node positive disease after surgery, in this study was 50%.…”

Surgical Management of Bladder Carcinoma

“…In a review of the literature, this latter group consistently demonstrates higher rates for recurrence and worse survival compared to those with organ-confined disease. 28,[50][51][52][53][54] Representative results of tumor control from contemporary radical cystectomy series are presented in Table 4.…”

Gynecological cancers in developing countries: the challenge of chemotherapy in low-resources setting

“…For many reasons, most of malignancies in the third world are likely to be diagnosed at a more advanced stage (12) , and, moreover, many patients make their prognosis worse by failing to complete an adequate therapy or follow-up. Concerning this difficult state, Magrath has clearly defined the vicious cycle in which socioeconomic deprivation would lead to the need of higher and higher financial resources and more health structures and services (6) .…”