Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort.

Walter Luiz Ribeiro Cabral,Renato B. Corradi,Carlos Corradi,Gustavo Jaime Climaco Galvão,Gabriel M. Oliveira,Wadson Gomes Miconi,Andre Lopes Lopes Salazar,Paulo Guilherme Oliveira Salles,Vinicius F. Carneiro

doi:10.1590/s1677-5538.ibju.2015.0380

Abstract

ABSTRACTIntroduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery.Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients.Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

Highlights

Introduction and ObjectiveRadical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique
Patients We identified 128 patients submitted to radical cystectomy from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil)
The majority of the patients submitted to cystectomy in our institution were men with a median age of 67 years, ranging from 36 to 86 years and more than 90% of them presented with invasive disease in the specimen pathology; 47% with pT3-pT4 disease and 16% with pT4 tumors

Summary

Introduction

Introduction and ObjectiveRadical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and a curative procedure for patients with organ confined and some with extravesical and node positive disease [1, 2] This surgical approach provides proper disease staging based on specimen pathology and, thereafter, adjuvant treatment strategies when indicated. The pelvic lymphadenectomy (LND) is not standardized among surgeons and institutions and its extension has been shown to be a determinant factor for improving progression-free and overall survival in patients with invasive bladder cancer submitted to RC [7] Another important point in the management of this disease is the reconstruction of the urinary tract and different urinary diversions have been described, none of them showed superiority compared to others in terms of complications and quality of life in prospective randomized trials

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Discussion

Conclusion