Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

Origin, Trajectory and Relationships of the Major Splancnic Nerve / Origen, Trayecto y Relaciones del Nervio Esplácnico Mayor

The major splancmc nerve is part of the nervous simpathic system and is placed in the posterior mediastine heading for the abdomen to innerve the abdominal visceras, and it's anatomical knowledge is of great importance to surgical procedures on this region. A descriptive anatomical study aimed to study the origin, trajectory and relationship of the major splancnic nerve. 44 nerves from 22 adult bodies, from both sex, from no defined race and maintained in formol at 10% were dissected. Many ways of origins to the splacnic nerve were observed, with only 7 cases being concordant with the researched authors. There were 25 nerves (56%) made from non sequenced origins. From the right nerves, 14 (63,8%) from the 22 cases originated from three or four roots from the simpathic trunk. In 12 (54,5%) left nerves, two or three contributions from the simpathic range were predominant. 22 nerves (16 from the right and 6 from the left) followed the descendant rout on the medial way and 22 nerves (6 from the right and 16 from the left) headed down following the spine side outline with no medial return. 21 nerves were found (6 from the right and 15 from the left) in a lateral location to the thoracic spine, 16 front-lateral nerves (9 from the right and 7 from the left) and 7 right nerves were anterior to the spine. We concluded there's no origin standard to the major splancnic nerve due to its large variety of origins. The major splancnic nerve may be placed in front to the thoracic spine after it's formation. Therefore, it's expected that this study may enlarge knowledge about the major splancmc nerve and reduce the risks caused by its damage in surgical procedures in the posterior mediastine.

El nervio esplacnico mayor es parte del sistema nervioso simpático y se ubica en el mediastino posterior, se dirige hacia el abdomen para inervar las visceras de la región. Su conocimiento anatómico es de importancia en los procedimientos quirúrgicos que se realizan en el abdomen. Este trabajo tuvo como objetivo estudiar el origen, trayecto y relaciones del nervio esplacnico mayor Fueron disecados 44 nervios de 22 cadáveres adultos, formolizados al 10%, de ambos sexos de diferentes razas. 25 nervios (56%) no tenían un origen secuencial. En el lado derecho, 14 casos (63,8%) se originaron a partir de tres o cuatro raíces del tronco simpático. En el lado izquierdo, en 12 casos (54%), el rango de contribución simpática predominante fue de dos o tres raíces. 22 nervios (16 del lado derecho y 6 del izquierdo) siguieron su descenso medialmente y los restantes 22 nervios (6 del lado derecho y 16 del izquierdo) se dirigieron caudalmente siguiendo la columna vertebral, contorneándola lateralmente sin dirigirse hacia medial. Se encontraron 21 nervios (6 del lado derecho y 15 del izquierdo) en una ubicación lateral a la columna vertebral torácica, 16 nervios en una ubicación anterolateral (9 del lado derecho y 7 del izquierdo) y 7 nervios derechos ubicados anterior a la columna vertebral. Concluimos que no hay un origen estándar del nervio esplacnico mayor . El nervio esplacnico mayor puede ubicarse anterior a la columna vertebral luego de su formación. Se espera que este estudio contribuya al conocimiento del nervio esplacnico mayor y así reducir el riesgo causado por daños en los procedimientos quirúrgicos realizados en el mediastino posterior.