Perioperative Morbidity of Radical Cystectomy: A Review

Overview

Journal Indian J Urol

Specialty Urology

Date 2011 Aug 5

PMID 21814314

Citations 11

Authors

Jagdeesh N Kulkarni

Affiliations

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Abstract

A systematic review of the literature on perioperative morbidity (POM) was done using Medline software with a combination of keywords like mortality, morbidity, and complications. In addition, we review the analysis of our hospital data of 261 Radical cystectomies (RCs) performed in an 11-year period and our latest clinical pathway for RC. Age range in our series was 50 to 81 years with 240 males and 21 females. RCs were performed by intraperitoneal method in 172 patients and by our extraperitoneal (EP) method in 89 patients. Urinary diversion was ileal conduit in 159 patients and neobladder in 102 patients. Blood loss ranged between 500 and 1500 ccs. Postoperative mortality occurred in eight patients (3%). Among the other early post-op complications, major urinary leak was seen in nine and minor in 11, requiring PCN in five patients and reoperation in four patients. Bowel leak or obstruction was seen in six and four patients, respectively, requiring reoperation in six patients. EP RC in our series showed some benefit in reduction of POM. The mortality of RC has declined but the POM still ranges from 11 to 68%, as reported in 23 series (1999-2008) comprising of 14 076 patients. Various risk factors leading to POM and some corrective measures are discussed in detail. However, most of these series are retrospective and lack standard complication reporting, which limits the comparison of outcomes. Various modifications in open surgical technique and laparoscopic and Robotic approaches are aimed at reduction in mortality and POM of RC.

Citing Articles

Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion.

Fuschi A, Al Salhi Y, Sequi M, Velotti G, Martoccia A, Suraci P J Clin Med. 2022; 11(1).

PMID: 35011876 PMC: 8745776. DOI: 10.3390/jcm11010136.

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center.

Fadlalla W, Hanafy A, Abdelhakim M, Aboulkassem H, Ashraf E, Abdelbary A Adv Urol. 2021; 2021:4731013.

PMID: 34306069 PMC: 8279872. DOI: 10.1155/2021/4731013.

Drain fluid creatinine-to-serum creatinine ratio as an initial test to detect urine leakage following cystectomy: A retrospective study.

Regmi S, Bearrick E, Hannah P, Sathianathen N, Kalapara A, Konety B Indian J Urol. 2021; 37(2):153-158.

PMID: 34103798 PMC: 8173937. DOI: 10.4103/iju.IJU_396_20.

The clinical and economic burden of perioperative complications of radical cystectomy.

Liaw C, Winoker J, Wiklund P, Sfakianos J, Galsky M, Mehrazin R Transl Androl Urol. 2019; 8(Suppl 3):S277-S279.

PMID: 31392144 PMC: 6642960. DOI: 10.21037/tau.2019.03.04.

Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission.

Flamiatos J, Chen Y, Lambert W, Acevedo A, Becker T, Bash J J Robot Surg. 2018; 13(1):129-140.

PMID: 29948875 DOI: 10.1007/s11701-018-0832-3.

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