UROLOGICAL ONCOLOGY

Perioperative Complications of Radical Cystectomy in a Contemporary Series
Novotny V, Hakenberg OW, Wiessner D, Heberling U, Litz RJ, Oehlschlaeger S, Wirth MP
Department of Urology, Technical University, Dresden, Germany
Eur Urol. 2007; 51: 397-401

• Objectives: Radical cystectomy is the preferred standard treatment for patients with muscle-invasive bladder cancer. With improvements in intra- and perioperative care lower complication rates have been reported. We retrospectively evaluated our series of patients who underwent radical cystectomy for advanced bladder cancer for perioperative complications as well as operative time, postoperative hospital stay and transfusion rates.
• Patients and Methods: Between April 1993 and August 2005, 516 radical cystectomies were performed for muscle infiltrating transitional cell carcinoma and other types of neoplastic diseases of the bladder at our institution. The average age was 66.3 yr (31-89).
• Results: The perioperative mortality rate was 0.8%. A total of 141 patients (27.3%) developed at least one perioperative complication. The most frequent medical complications were subileus in 20 (3.9%) patients, deep venous thrombosis in 24 (4.7%), and enterocolitis in 10 (1.9%). Surgical complications included pelvic lymphoceles in 42 (8.1%) patients, wound dehiscence in 46 (8.9%), pelvic hematoma in 4 (0.8%), peritonitis in 4 (0.8%) and small bowel obstruction in 4 (0.8%). The total early reoperation rate was 6.2%. Operative time, postoperative hospital stay and average number of blood units transfused decreased over the period 1993-2005.
• Conclusions: Radical cystectomy today is a procedure with an acceptable rate of perioperative morbidity and mortality. Improvements in surgical technique and anaesthesia as well as increased quality of perioperative care in recent years have resulted in reduced morbidity and shorter hospital stay.
  
  
• Editorial Comment
  This article focuses on the complications of a large cystectomy series of a so-called high-volume center with around 40 cystectomies annually. The complication rate in this series, which is very identical to other large volume series, is roughly around 30%, mortality at 1%. Interestingly, median operative time for ileal conduits was 5.7 hours and for neobladders 6.5 hours.
  Patients should be counseled about these realistic data before surgery.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: aboehle@badschwartau.helios-kliniken.de