Vol. 42 (3): 431-437, May – June, 2016
Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort
Renato B. Corradi 1, Gustavo Jaime Climaco Galvão 1, Gabriel M. Oliveira 1, Vinicius F. Carneiro 1, Wadson Gomes Miconi 1, Paulo Guilherme Oliveira Salles 1, Walter Luiz Ribeiro Cabral 1, Carlos Corradi 2, Andre Lopes Lopes Salazar 1
1 Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil; 2 Departamento de Urologia, Hospital das Clínicas UFMG, Belo Horizonte, MG, Brasil
Introduction 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 compli¬cations 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 me¬dium 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 pa¬thologic 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.
Keywords: Cystectomy; Lymph Node Excision; Urinary Bladder Neoplasms; Therapeutics