Perioperative outcomes of open radical cystectomy in bladder carcinoma: King Chulalongkorn Memorial Hospital experiences

Abstract

Background : Radical cystectomy is the treatment of choice for muscle-invasive and refractory superficial bladder carcinoma.

Objectives : To report the perioperative outcomes and complications of open radical cystectomy.

Materials and Methods : We retrospectively reviewed all medical records of patients who underwent open radical cystectomy for bladder carcinoma at our hospital between January 2003 and June 2013. Patients’ demographic data, operative outcomes and pathological study were recorded. Thirty-day postoperative complications were
classified by modified Clavien Classification.

Results : One hundred and forty-four patients with mean age of 64 years were included. There were 115 males and 29 females in this study. Nineteen patients had concomitant procedure (9 unilateral nephroureterectomy, 1 bilateral nephroureterectomy and 9 urethrectomy). Ileal conduit was the major procedure for urinary diversion (91.6%). Mean operative time was 340 minutes. Mean estimated blood loss was 2,177 ml. Postoperative complication rate was 83.3% included 17.4% of major complications (CCSC grade 3). The most common complications were electrolyte imbalance, anemia required transfusion and prolonged ileus. Four (2.8%) mortalities occurred from severe septicemia with multi-organ failure. The pathological study showed high grade
transitional cell carcinoma (79%) was the most common cell type and 70.4% of patients were muscle invasive bladder carcinoma.

Conclusion : Although radical cystectomy had high complication rate, the majority of them minor complications and could be managed conservatively. It is, however, a standard treatment in muscle invasive bladder carcinoma.