Perioperative morbidity of radical cystectomy: A review

Kulkarni, Jagdeesh N.

doi:10.4103/0970-1591.82842

Cited by 21 publications

(27 citation statements)

References 43 publications

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“…Contemporary mortality and morbidity rates of patients undergoing RC are lower than in previous decades [24,25]. Prior to 1990, the perioperative mortality in large series (>100 subjects) ranged from 2.4 to 15%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

Comploj¹,

West

Mian

et al. 2014

Urol Int

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Introduction: The purpose of this study was to evaluate and compare complications after radical cystectomy in patients aged ≥75 years. Materials and Methods: 251 patients aged 75-95 years (median 79) underwent radical cystectomy between 2000 and 2012 at four institutions. The patients were divided into two groups: ≥75-84 years of age (group 1) versus ≥85 years of age (group 2). Comorbidities, body mass index, and complications were obtained retrospectively, except at the Central Hospital of Bolzano and Weill Cornell Medical Center, which collected data prospectively. Cancer-specific survival, overall mortality, hospital stay, clinical outcome and complications were assessed. Complications were categorized using the Clavien-Dindo classification reporting system. The mean follow-up was 21 months. Results: The median hospital stay was 17 (2-91) days. Perioperative Clavien-Dindo grade ≥III complications were seen in 24.1% (48/199) of group 1 patients and 19.2% (10/52) of group 2 patients (p = 0.045). 30- and 90-day mortality was 4.5 and 13.5% in group 1 and 6.5 and 32.3% in group 2, respectively. Only the 90-day mortality rate was statistically significant (p < 0.05) between the two groups. The 3-year overall survival was 40% in group 1 and 34% in group 2. The 3-year cancer-specific survival was 52% in group 1 and 50% in group 2. Conclusions: We evaluated a large series of elderly (≥75 years) patients undergoing radical cystectomy at four institutions. Comparing patients aged ≥75-84 and ≥85 years revealed no significant difference in complications, 30-day mortality, overall and cancer-specific survival rates. Only 90-day mortality rates were significantly higher in the ≥85-year-old patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

Comploj¹,

West

Mian

et al. 2014

Urol Int

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“…After removing the epidural catheter after 72 hours, oral medication proved sufficient (NAS max. [3][4].…”

Section: Resultsmentioning

confidence: 99%

Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: To assess the feasibility and performance of radical cystectomy with urinary diversion using exclusively regional anesthesia (i.e. combined spinal thoracic epidural anesthesia, CSTEA). Materials and Methods:In 2011 radical cystectomy with extended pelvic and iliac lymphadenectomy was performed on 14 patients using urinary diversion without applying general anesthesia. Under maintained spontaneous breathing, the patients were awake and responsive during the entire procedure. Postoperatively, pain management took three days with the remaining epidural catheter before oral analgesics were administered. Mobilization and diet restoration were carried out according to the fast-track concept. Outcome measurements included operative time, blood loss, beginning of oral nutrition, beginning of mobilization, postoperative pain levels using numerical and visual analog scales (NAS/VAS), length of hospital stay. Results: All surgical procedures were performed without any complications. The absence of general anesthesia did not result in any relevant disadvantages. The postoperative progress was normal in all patients. Particularly, cardiopulmonary complications and enteroparesis did not occur. The provided palliative care proved sufficient (NAS max. 3-4). Discharge followed 10 to 22 days after surgery. At the time of discharge, the patients described the procedure to be relatively positive. Conclusions: Our data show that CSTEA is an effective technique for radical cystectomy, whereby spontaneous breathing and reduced interference with the cardiopulmonary system potentially lower the perioperative risks especially for high-risk patients. We recommend practice of CSTEA for radical cystectomy to further evaluate and monitor the safety, efficacy, outcomes, and complications of CSTEA.

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“…Regardless of the approach used, radical cystectomy remains a morbid operation with complication rates ranging between 26 and 64% and mortality rates between 1 and 7% [24,25]. Readmission following radical cystectomy is also common with bowel-related and urinary complications most prevalent.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

Rao

Stegemann

Rehman

et al. 2012

Indian J Surg Oncol

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Robot-assisted radical cystectomy (RARC) for bladder cancer is increasingly becoming popular in specialist centres around the world. RARC has the advantage of being minimally invasive and also the dexterity of the instruments allow reconstruction such as ileal conduit urinary diversion or neobladder formation. Starting from the initial series demonstrating the feasibility of RARC and extended pelvic lymph node dissection, we now have mature series demonstrating equal oncological and functional outcomes in the medium term follow-up. In addition, literature suggests decreased hospital stay, less blood loss equating to less blood transfusion and a trend towards decreased complications as well. In the near future we would anticipate further refinement and reduced operating times with increased benefits for the patient undergoing RARC.

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Perioperative morbidity of radical cystectomy: A review

Cited by 21 publications

References 43 publications

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

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