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Abstract
The purpose of this paperwork is to assess the oncological findings and the morbidity rate after complete cystectomy in our department. Patients and methods: We conducted a backward and descriptive study during a 80-month-period range from September 2011 to May 2018, in the Urology Department of Aristide Le Dantec Teaching Hospital standing as a referral structure in our country (Senegal). Results: Nineteen patients were included accounting for 13 men and 6 women corresponding to a sex ratio of 2. The mean age was at 58 years old (extremes range from 32 to 77 years old). Radical cystectomy consisted of an anterior pelvectomy and transileal cutaneous ureterostomy by Bricker approach in 6 women, a radical cystoprostatectomy with transileal cutaneous ureterostomy by Bricker approach in 12 men and a radical cystoprostatectomy followed by Studer orthotopic neobladder in 1 patient. Early post-operative morbidity consisted of one case of parietal suppuration (grade I), two cases of evisceration (grade IIIb), one case of digestive fistula (grade IIIb), and uroperitoneal peritonitis (grade IIIb) secondary to suture loosening of the uretero-ileal anastomosis (which occurred in the patient who had Studer neobladder). This patient died in resuscitation ward after surgical repair of the uretero-iliary anastomosis. Late complications were a case of acute pyelonephritis three months after cystectomy and a case of flanged occlusion. Two patients with urothelial carcinoma had received adjuvant chemotherapy using the M-VAC protocol. After an average follow-up of 15 months we recorded 13 deaths, three patients were lost of sight and three others respectively lived 4 years and 2 months, 5years and 8 months and 6years and 8 months after radical cystectomy. Mean overall survival was 15 months (4.2 to 25.8 months) with a median survival of 6 months. The only patient who had Studer neobladder died one week after cystectomy. The mean overall survival after previous pelvectomy was 17.2 months and that after cystoprostatectomy was 15.18 months. Conclusion: This work highlights the very poor prognosis of bladder cancers in our context linked to the advanced stage of tumours at the time of diagnosis, the rarity of endoscopic equipment essential for the diagnosis, treatment and monitoring of bladder cancers, the frequency of radiochemically resistant squamous cell carcinoma, the unavailability of chemotherapy in urothelial carcinoma to enable multimodal treatment, and the heaviness and complexity of radical cystectomy.
Highlights
Bladder cancer is the 7th most prevalent malignancy worldwide and mostly occurs after 60 years of age [1]
The general appearance of patients were assessed by using the American Society of Anesthesia Score (ASA) and the clinical stage according to TNM classification 2009 set by the UICC
Radical cystectomy consisted of an anterior pelvectomy and transileal cutaneous ureterostomy by Bricker approach in 6 women, a radical cystoprostatectomy with transileal cutaneous ureterostomy by Bricker approach in 12 men and a radical cystoprostatectomy followed by Studer orthotopic neobladder in 1 patient
Summary
Bladder cancer is the 7th most prevalent malignancy worldwide and mostly occurs after 60 years of age [1]. In our context, this condition is the 2nd type of cancer after prostate cancer and is followed by kidney cancer [2]. The core therapy of bladder cancers with muscle invasion relies on radical cystectomy This a heavy surgical approach known by its mutilant character and its high immediate and long-term postoperative fatality. The purpose of this paperwork is to assess the oncological findings and the morbidity rate after complete cystectomy in our department
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