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Short Term Complications post Radical Cystectomy South Egypt Cancer Institute: 5 years’ experience

Introduction: Radical cystectomy represents the standard treatment of muscle-invasive bladder cancer and nonmuscle invasive bladder cancer (intra-vesical therapy). [1] Despite advances of surgical technique and perioperative management, radical cystectomy has been associated with a substantial risk of postoperative morbidity and mortality with variable rates of shortterm complications and mortality. [2] However, with advances patient selection, perioperative management and surgical technique, it currently has acceptable low perioperative mortality rate and a low rate of complications which are manageable. [3] Risk assessment tools, such as the modified Charlson Comorbidity Index, Cardiac Risk Index (Lee Criteria), and the American Society of Anesthesiologists Physicians Status Classification are widely adopted to counsel bladder cancer patients and guide selection of surgical candidates. [4] A successful outcome with radical cystectomy depends upon surgical technique, safe extirpation of the bladder and on factors such as patient selection, coordinated perioperative care, and use of adjunctive treatments. [5] The aim of our study was to define the surgical outcome of radical cystectomy in urinary bladder cancer management in the point of postoperative morbidities and mortalities related to different surgical procedures aiming to minimize them to achieve the best outcomes possible. Abstract Background: Despite advances of surgical technique and perioperative management, radical cystectomy has been associated with a substantial risk of postoperative morbidity and mortality with variable rates of short-term complications and mortality. However, with meticulous patient selection, perioperative management and surgical procedures, it currently has acceptable low perioperative mortality rate and a low rate of complications which are manageable. The aim of this study was to define the surgical outcome of radical cystectomy for urinary bladder cancer management in the point of postoperative morbidities and mortalities related to different surgical procedures aiming to minimize them to achieve the best outcomes possible. Method: This is a retrospective study of 456 patients who had underwent radical cystectomy at South Egypt Cancer Institute between a time period from January 2012 till December 2016, the data were collected from archive and cancer registration data base of surgical oncology department. Results: The age of presentation was 57.7 ± 9.4 ranged from 34 to 87 years. Male to female ratio was 71.7%., 28.3% respectively. Sixteen percent of patients were hypertensive, 13.2% diabetic and 19.7% had liver cirrhosis. The average duration of hospital stay was 14.6±6.2 days and average operative time (hour) was 4.3±1.4 hours. Most of patients (3/5) showed backpressure on kidneys (63.2%). The commonest diversion performed after radical cystectomy was ileal conduit diversion (39%) then ureterocolic diversion (30.9%), followed by orthotopic diversion (14.9%) and ureterocutenous diversion (12.9%) with a few percentage with rectal bladder (2.2%). Only 7.9% of patients received neoadjuvant chemotherapy. Intra-operative complications were recognized in only 5.3% of patients. 64% of patients experienced one or more of post-operative complications within 90 day of surgery with the most common complication categories were sexual dysfunction (73.46%), genito-urinary (52.19%), gastro intestinal (48.25%), wound-related (41.25%), general (30%), lymphadenectomy-related (21%), pulmonary (6%) and psychological complications (2.6%). Conclusion: Radical Cystectomy is a complex operation and has avoidable post-operative Morbidity and mortality. Various technical improvements of the surgical and anesthesia techniques, multi-disciplinary approach for correction/control of comorbidities and early postoperative rehabilitation have produced salutary effect in reducing the mortality.