Introduction and Objectives
Radical cystectomy is a challenging operation, often performed on elderly patients with associated comorbidities that require diligent attention to pre-, intra-, and postoperative details. Despite this, complications do occur. It is important for all surgeons to be familiar with the presentation, prevention, and treatment of the major causes of morbidity and mortality associated with radical cystectomy and lower urinary tract reconstruction. We sought to analyze the perioperative events after radical cystectomy and urinary diversion in bladder cancer and to seek relationships with patient's characteristic and surgical procedures.
Material and Methods
Between January 2006 and December 2008, 73 consecutive patients (82% male) underwent radical cystectomy and urinary diversion for primary carcinoma of the bladder, at our hospital. The average age was 63 yr (34–81). The preoperative characteristic of the patients (age, sex, hemoglobin, comorbidities) and perioperative data (operative time, type of urinary diversion, associated procedures) were recorded. Perioperative morbidity was defined by any adverse event during hospital stay or within 30 days after surgery.
The perioperative mortality and morbidity rate were 2.73% and 35%. The most frequent medical complications were ileus (15%), urinary tract infection (4.1%) and sepsis (4.1). Surgical complications included evisceration (6.8%), wound infection and wound dehiscence (6.8%) and urinary fistula (4.1%). Between age and perioperative complications there was a significant correlation from the statistical point of view (Spearman's correlation coefficient r = 0.23, p < 0.05). No relationships between biological parameters, type of diversion, associated procedure and perioperative complications could be revealed. The postoperative hospital stay was significantly longer in patients with complications (25±8 d) compared with patients without complications who had a mean postoperative hospital stay of 18±5 d.
Radical cystectomy remains an operative procedure with significant morbidity and potentially lifethreatening complications. Thanks to a thorough understanding and improvement in surgical technique and perioperative anesthetic care, the early mortality from radical cystectomy has decreased from nearly 20% before 1970 to 5% in most contemporary series.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.