Безопасность спасительной цистэктомии после неудачи органосохраняющего лечения больных мышечно-инвазивным раком мочевого пузыря

Abstract

Purpose: To prove the safety of the salvage cystectomy after organ preserving treatment in patients with muscle invasive bladder cancer.
 Material and methods: In the research retrospective data of 130 patients with muscle invasive transitional cell carcinoma of the bladder were selected. In the main group 66 patients undergoing of the salvage cystectomy after radiotherapy were included, in the control group – 64 patients who underwent of radical cystectomy without prior treatment. The main and control groups were matched by age, gender, category with cN (p > 0.05 for all). In the main group tumors which were beyond the bladder wall, hydronephrosis were more frequently diagnosed; during the salvage operations pelvic lymph node dissection rarely performed (p = 0.03) and orthotopic bladder substitution was made (p = 0.027).
 Results: The median of duration of the salvage cystectomy was 310 min, which was not significantly different from 300 minutes in the control group (p = 0.711). The median of amount of bleeding of the patients undergoing surgery after irradiation, was not significantly lower than that the patients who had cystectomy which performed without prior radiation therapy (1329 and 1802 ml respectively, p = 0.118). The frequency of intraoperative complications of saving cystectomy was 10.6 %, which did not differ from 7.8 % in the control group (p = 0.300). Only one kind of complication of cystectomy after radiation therapy was difficult to control the bleeding in 6 cases (9.1 %). The frequency of postoperative complications – 42.7 % in the main and control group 42.2 % (p = 0.530). The perioperative mortality was equal to 6.1 %. The operating time, blood loss, frequency, structure and severity of complications i did not differ significantly n the main and control groups (p > 0.05 for all).
 Conclusion: The salvage cystectomy is indicated to a sick muscle-invasive bladder cancer with an incomplete effect, relapse or intolerable toxicity, organ-preserving treatment, including radiation therapy. Desmoplastic reactions of the irradiated tissue cause the technical complexity of the interference and worsen the conditions for reparation. The most common intraoperative complication of salvage cystectomy is bleeding, in the structure of postoperative complications infections, intestinal obstruction and complications of the urinary anastomoses dominate. The accumulation of surgical experience make the frequency and severity complications of the salvage radical cystectomy comparable, offsetting an increase of operational risk in previously irradiated patients.