title: Long-term follow-up after radical cystectomy with emphasis on complications and reoperations: a Swedish population-based survey.
abstract: OBJECTIVE
  To evaluate outcome after radical cystectomy for primary bladder cancer in a large population-based material.
  
  
  METHODS
  Between 1997 and 2002 all patients treated with radical cystectomy within 3 months after diagnosis of primary bladder cancer without distant metastasis were retrieved through the Swedish Bladder Cancer Registry. A follow-up questionnaire was distributed to all units where the primary registration of patients was performed. Follow-up data on recurrence date were retrieved from the patient charts and causes of death were obtained from the Swedish Cause of Death Registry until 2003.
  
  
  RESULTS
  During the study period radical cystectomy was performed in 39 units in Sweden, of which only five units were considered high-volume hospitals performing 10 or more procedures annually. Mean blood loss was 2300 ml (median 2000 ml) and the 90-day mortality rate was 5.7%. Blood loss was higher in high-volume units than in hospitals with lower hospital volumes, but the 90-day mortality rates were similar. During a median follow-up of 3.5 years, 24% of the patients were submitted to a reoperation. Reoperation rates were significantly higher in patients who received a continent urinary diversion (29%) compared with an ileal conduit (22%, p < 0.015).
  
  
  CONCLUSIONS
  Radical cystectomy was associated with a reoperation rate of 24% in Sweden during the study period. The reoperation rates were higher in patients receiving a continent cutaneous diversion or bladder substitution. Blood loss was higher in high-volume units; otherwise, surgical volume did not affect mortality rates, cancer-specific survival or reoperation rates.
authors.affiliation: Department of Urology, Växjö County Hospital, Växjö, Sweden. f.liedberg@telia.com
authors.forename: Fredrik
authors.initials: F
authors.lastname: Liedberg
authors.forename: Erik
authors.initials: E
authors.lastname: Holmberg
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.forename: Wiking
authors.initials: W
authors.lastname: Månsson
authors.forename: Leyla
authors.initials: L
authors.lastname: Nunez
authors.forename: Catrin
authors.initials: C
authors.lastname: Wessman
authors.forename: Hans
authors.initials: H
authors.lastname: Wijkström
authors.forename: Staffan
authors.initials: S
authors.lastname: Jahnson
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*