title: Performing radical cystectomy and urinary diversion in regional anesthesia: potential risk reduction in the treatment of bladder cancer.
abstract: OBJECTIVE
  To assess the feasibility and performance of radical cystectomy with urinary diversion using exclusively regional anesthesia (i.e. combined spinal thoracic epidural anesthesia, CSTEA), avoiding the adverse effects of general anesthesia.
  
  
  METHODS
  In our hospital, radical cystectomy with extended pelvic and iliac lymphadenectomy and urinary diversion was performed on 28 patients using CSTEA without applying general anesthesia, in 2011 and 2012. Under maintained spontaneous breathing, the patients were awake and responsive during the entire procedure. Outcome measurements included operative time, blood loss, start of oral nutrition, start of mobilization, postoperative pain levels using numerical and visual analog scales (NAS/VAS), postoperative complications according to the Clavien-Dindo classification and length of hospital stay.
  
  
  RESULTS
  All surgical procedures were performed without any complications and caused no anesthesiologically or surgically untoward effects. We observed no more severe complications than grade 1 according to the Clavien-Dindo classification.
  
  
  CONCLUSIONS
  Our data show that CSTEA is an effective and safe technique for radical cystectomy, whereby spontaneous breathing and reduced interference with the cardiopulmonary system potentially lower the perioperative risks, especially for high-risk patients. We recommend practice of CSTEA for radical cystectomy to further evaluate and monitor the safety, efficacy, outcomes and complications of CSTEA.
authors.affiliation: Department of Urology, HELIOS Klinikum GmbH Berlin, Germany. ffreksa@gmx.de
authors.forename: M
authors.initials: M
authors.lastname: Friedrich-Freksa
authors.forename: E
authors.initials: E
authors.lastname: Schulz
authors.forename: T
authors.initials: T
authors.lastname: Nitzke
authors.forename: O
authors.initials: O
authors.lastname: Wenzel
authors.forename: G
authors.initials: G
authors.lastname: Popken
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D010147:Pain Measurement; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*