Complications of Radical Cystectomy for Carcinoma of the Bladder

Abstract

Consecutive patients (165) underwent radical cystectomy for bladder cancer, 19 patients without preoperative radiation therapy, 109 patients after planned preoperative radiation therapy and 37 patients after failure of definitive radiation therapy (salvage cystectomy). The operative mortality was 2.4% of the entire group, less than 1% of the 128 patients undergoing cystectomy as primary treatment and 8.1% of the 37 patients undergoing salvage cyst ectomy. Early complications occurred in 28% of the 165 patients and included wound infection, urine leak, ureterointestinal obstruction, small bowel obstruction, intestinal leak, rectal fistula and/or medical complications. Postoperative hospitalization for those patients suffering any complication averaged 27 days compared to the average hospitalization of 12.7 days when no complications occurred. Selective use of the initial perineal approach in male patients who had received more than 6000 rad and of staged cystectomy after urinary diversion in some high risk patients, associated with salvage cystectomy, can reduce the postoperative mortality and morbidity significantly. The addition of a meticulous pelvic iliac lymph node dissection did not increase the operative mortality or morbidity compared to simpler procedures. The early aggressive use of single radical cystectomy with pelvic iliac lymph node dissection and urinary diversion in the management of patients with bladder cancer is supported.