A critical analysis of perioperative mortality from radical cystectomy.
OBJECTIVE
Operative mortality from radical cystectomy has decreased as a result of improvements in surgical and anesthetic care. We reviewed the perioperative deaths from a large group of patients treated with radical cystectomy for primary bladder cancer.


METHODS
All perioperative mortalities from radical cystectomy were identified from a single high volume institution. The medical records were reviewed to assess the cause of death as well as possible contributing factors.


RESULTS
From August 1971 to December 2001, 1,359 patients with primary bladder cancer were treated with radical cystectomy and pelvic iliac lymphadenectomy at our institution. Of these patients, 27 (2%) died within 30 days of surgery or before discharge from hospital. Median patient age at surgery was 67 years (range 47 to 78) and males accounted for 81% of the patients. The median time to death was 28 days from cystectomy (range 0 to 80). Most deaths were cardiovascular related (including acute myocardial infarction, cerebrovascular accident, arterial thrombosis) or due to septic complications with resulting multi-organ system failure, followed by pulmonary embolism, hepatic failure and hemorrhage. Septic related mortality was most often associated with postoperative urine or bowel leak. While most deaths occurred before hospital discharge, 2 patients died at home due to a late pulmonary embolus. No association was seen between pathological stage or type of urinary diversion and mortality.


CONCLUSIONS
Perioperative mortality from radical cystectomy is low in this group of patients. Most deaths are due to cardiovascular or septic complications. Careful patient selection and meticulous surgical technique may help decrease the incidence of perioperative mortality.
Quek
Marcus L
ML
Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California, USA. mquek@lumc.edu
Stein
John P
JP
Daneshmand
Siamak
S
Miranda
Gus
G
Thangathurai
Duraiyah
D
Roffey
Peter
P
Skinner
Eila C
EC
Lieskovsky
Gary
G
Skinner
Donald G
DG
D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*