Analysis of the perioperative and five-year oncological outcome of two hundred cases of open radical cystectomy: A single center experience.

Objectives: We prospectively evaluated our perioperative and five-year oncological results of 200 cases of open radical cystectomy with urinary diversion, for formulating contemporary benchmarks, for future comparison of minimally invasive techniques. This is one of the largest prospective series reported from India of open radical cystectomy. Materials and Methods: Between 2004 and 2009, patients undergoing open radical cystectomy with urinary diversion, at our institution, were prospectively enrolled in the study. Data were recorded and analyzed statistically. Results: Two hundred patients were enrolled in the study. The mean age was 65.1 years. The patients undergoing ileal conduit and orthotopic neobladder were 159 (79.5%) and 41 (20.5%), respectively. The mean operating time was 275 minutes. The mean operating time for ileal conduit and orthotopic neobladder were 262 minutes and 288 minutes, respectively. The mean estimated blood loss was 690 ml. Blood transfusion was required in 37 (18.5%) patients. The mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) patients, respectively. Perioperative mortality was recorded in only two (1.5%) patients. The pathologically organ-confined and non-organ-confined cases were 135 (67.5%) and 65 (32.5%), respectively. Thirty-three (16.5%) patients had pathologically confirmed lymph nodes. Median follow-up was 60.1 months. Local recurrence and distant metastases were recorded in 16 (8%) and nine (4.5%) patients, respectively. A five-year disease-free survival, cancer-specific survival, and overall survival were 75.5, 71.5, and 63.5%, respectively. Conclusions: Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable five-year oncological efficacy. Minimally invasive techniques need a long-term prospective comparison with this approach, before being accepted as a standard treatment for urinary bladder malignancy.

Derivaciones urinarias con conducto intestinal / Urinary diversions with intestinal duct

Se analizan 42 pacientes operados en forma consecutiva en nuestro Servicio. Su edad promedio fue de 59 años (rango de 19 a 78 años), 37 hombres y 5 mujeres. La indicación de la derivación fue por cistectomía total en cáncer vesical en 35 casos (83,3%) y como derivación paliativa en 6 casos de cáncer avanzado y 1 caso de fístula vesical (16,7%). El segmento intestinal más utilizado fue íleon en 31 oportunidades (73,8%), colon sigmoideo en 10 (23,8%) y el segmento íleo-cecal en 1 (2,4%). La mortalidad fue de 14,3% (5 pacientes) en aquellos casos de cistectomía total y sólo uno fallece a consecuencia de una fístula intestinal. En el grupo de derivación paliativa, sin cistectomía, la mortalidad fue de un 57,1% (4 pacientes), en 3 de ellos la relación a dehiscencia de la sutura intestinal. El control alejado (hasta 16 años) demuestra una incidencia de 17,2% de complicaciones del estoma (4 dermatitis y 1 hernia paraestomal) todas ellas de rápida solución. La adaptación psicológica ha sido excelente en el 83% de los casos y regular en 5 pacientes de corta evolución. La derivación urinaria tipo Bricker es una técnica quirúrgica con morbi-mortalidad elevada, pero la mejor alternativa en pacientes con cistectomía total. Su indicación debe ser limitada en pacientes con enfermedad tumoral avanzada y deterioro grave de su estado nutricional.