INTRODUCTION: Contemporary benchmarks of the short-term and long-term outcomes of open radical cystectomy (ORC) that can be used for future comparison of minimally invasive techniques are incomplete. The purpose of this prospective study was to evaluate the perioperative and 5-year oncological results of ORC with urinary diversion.
METHODS: Between 2004 and 2009, 200 patients undergoing ORC with urinary diversion were prospectively enrolled. Indications for ORC included: (1) muscle-invasive bladder cancer detected by transurethral resection, or (2) high-grade stage Ta, T1, or carcinoma in situ that was refractory to repeated transurethral resection and intravesical immunotherapy or chemotherapy. Patients with metastatic disease were excluded. Mean patient age was 65.1 years. Perioperative, histopathologic, and postoperative follow-up data were recorded and analyzed statistically.
RESULTS: Ileal conduits were constructed in 159 (79.5%) patients; an ileal orthotopic neobladder (Studerâ's procedure) was constructed in 41 (20.5%) patients. Mean operating time was 275 minutes. Mean estimated blood loss was 690 mL. Blood transfusion was required in 37 (18.5%) patients. Mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) of the patients, respectively. Perioperative mortality was recorded in 2 (1.5%) patients. Pathologically organ-confined and nonorgan-confined cancer was found in 135 (67.5%) and 65 (32.5%) patients, respectively; 33 (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 9 (4.5%) patients, respectively. The 5-year disease-free survival, cancer-specific survival, and overall survival rates were 75.5%, 71.5%, and 63.5%, respectively. Survival rates were significantly higher for patients with organ-confined cancers and negative lymph nodes.
CONCLUSIONS: Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable 5-year oncological efficacy. Minimally invasive techniques need long-term prospective comparison with this approach before they can be accepted as a standard treatment for urinary bladder malignancy.
Nayan K Mohanty, Anup Kumar, Pawan Vasudeva, Manoj Jain, Sanjay Prakash, Rajender P Arora
Submitted July 22, 2010 - Accepted for Publication September 6, 2010
KEYWORDS: Urinary bladder; Carcinoma; Radical cystectomy
CORRESPONDENCE: Professor Nayan K Mohanty, C-II/124, Moti Bagh-I New Delhi, 110 029, India ().
CITATION: Urotoday Int J. 2010 Oct;3(5).
doi:10.3834/uij.1944-5784.2010.10.08
