Grading complication following radical cystectomy and ileal conduit for bladder cancer using clavien grading system

To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system. An analytical descriptive study. The Aga Khan University Hospital, Karachi, from 1990 to 2010. Patients who had undergone ileal conduit [IC] formation, following radical cystectomy [RC] for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system [CG]. Results were presented using descriptive statistics. Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients [56.2%] did not have any complications. Most common complication of wound infection was seen in 7 patients [CG-2], followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia [GC-3a]. Mortality rate was 4.5%, classified as CG-V. Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life

Separate submission of standard lymphadenectomy in 6 packets versus en bloc lymphadenectomy in bladder cancer

Our aim was to evaluate detection of nodal metastasis during radical cystectomy with standard pelvic lymph node dissection versus en bloc lymphadenectomy for the treatment of bladder cancer. Hospital records of a total of 77 patients with radical cystectomy and either standard pelvic lymph node dissection or en bloc lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examination in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. En bloc dissection specimens were sent in 2 containers marked as the right and the left pelvic nodes. Clinical and pathological findings of these two groups were compared in terms of the number of dissected lymph nodes, number of nodes with metastasis, lymph node density, and clinical outcomes. There were 34 patients with standard lymph node dissection and 43 with en bloc lymphadenectomy [anterior pelvic exenteration]. Age, sex, duration of the disease, number of transurethral resections prior to cystectomy, pathological grade at cystectomy, and stage of the primary tumor were comparable in the two groups of patients. The median numbers of nodes removed per patient were 15.5 [range, 4 to 48] and 7.0 [range, 1 to 24] in those with standard and en bloc lymphadenectomy, respectively [P<.001]. Nodal involvement was detected in 10 [29.4%] and 9 [20.9%] patients, respectively [P=.43]. Although nodal involvement was not significantly different between the two groups, standard lymphadenectomy submitted in 6 different containers significantly improved the nodal yield over en bloc resection. Obturator nodes were the most commonly involved nodes in our study

Bilateral colloid carcinoma breast with axillary tuberculosis

A 62 years old female presented with painful lump right breast and bloody discharge from right nipple for two months, with a biopsy report of intraductal papilloma. Excision of the involved duct and lump was done. Histopathology revealed in situ ductal carcinoma with focus of invasion. She was further investigated with bilateral mammogram and fine needle aspiration cytology [FNAC]. Mammogram showed lesions in both breasts. FNAC from left breast showed atypical cells with suspicions of malignancy. Right modified radical mastectomy [MRM] and left mastectomy performed. Final biopsy report showed bilateral colloid carcinoma with axillary tuberculosis