A contemporary standard for morbidity and outcome after radical cystectomy.
OBJECTIVE
To report the temporal changes in peri-operative outcome over an extended period in patients undergoing radical cystectomy (RC) for all causes, irrespective of the previous treatment or pathology; and to establish a current standard of peri-operative outcome for RC by analysis of contemporary operative mortality rates (2000-5) factored for risk factors that might predict outcome.


METHODS
All patients undergoing RC between 1970 and 2005 were analysed; this was an unselected single-centre series and included patients previously treated by definitive radiotherapy, chemotherapy, and cases of RC where the primary tumour involved the bladder but was not of bladder origin.


RESULTS
In all, 846 patients had a RC, of whom 647 had a bladder primary tumour and 199 a primary tumour elsewhere (gynaecological, colorectal and others). There was a progressive reduction in 30- and 60-day mortality rates, such that the current peri-operative mortality (1999-2005) was 0.4% and 2.6%, respectively. There was a significant reduction in the re-operation rate over the decades (P=0.01), which is currently 4.7%. Patient age was a significant factor in 30- and 60-day mortality rates (P<0.001 for both) but there was no significant association between either American Society of Anesthesiologists grade or T stage with complication rates (P=0.61 and 0.12, respectively).


CONCLUSIONS
There has been a progressive reduction in mortality related to RC, associated with both cases of RC and pelvic exenteration. The contemporary standard for 30-and 60-day mortality rates for these operations is 0.4% and 2.6%, respectively.
Ramani
Vijay A C
VA
Department of Urology, The Christie NHS Foundation Trust, Manchester, UK. vijay.ramani@gmail.com
Bromage
Stephen J
SJ
Clarke
Noel W
NW
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D016879:Salvage Therapy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery