title: Radical cystectomy in the treatment of bladder cancer in Iceland: A population-based study.
abstract: OBJECTIVE
  Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer. Postoperative complications are reported to be as high as 65%. The objective of this study was to investigate complications and survival in Icelandic patients with bladder cancer who underwent RC.
  
  
  METHODS
  All patients who had bladder cancer and underwent RC in Iceland from 2003 to 2012 were included. Information was obtained retrospectively from patients' medical records and from the Icelandic Cause of Death Registry. Complications were classified according to the Clavien-Dindo classification system. The Kaplan-Meier method was used in the survival analysis. Only patients with transitional cell carcinoma (TCC) were included in the survival analysis.
  
  
  RESULTS
  Overall, 108 patients (male 81%, median age 68 years) underwent the procedure during the study period and 100 of them had TCC. Ileal conduit was performed in 86% of procedures and orthotopic neobladder in 14%. The median operation time was 266 min and the median blood loss during the procedure was 1000 ml. No patient died within 30 days of surgery, but one patient (0.9%) died within 90 days of surgery from complications of the surgery. Complications were reported for 62 patients (57%) overall. Major complications (Clavien 3-5) were reported in 32 patients (29%), and 30 patients (28%) had only minor complications (Clavien 1-2). Twenty-four patients (22%) had to undergo reoperation. Overall 5 year survival was 54%.
  
  
  CONCLUSIONS
  Morbidity after RC is high but similar to that seen in other studies. Long-term survival of Icelandic patients is comparable to that in neighboring countries.
authors.affiliation: a Department of Urology , Landspitali University Hospital , Reykjavik, Iceland.
authors.forename: Oddur
authors.initials: O
authors.lastname: Björnsson
authors.affiliation: a Department of Urology , Landspitali University Hospital , Reykjavik, Iceland.
authors.forename: Eirikur Orri
authors.initials: EO
authors.lastname: Gudmundsson
authors.affiliation: b Department of Surgery , Akureyri Hospital , Reykjavik, Iceland.
authors.forename: Valur Thor
authors.initials: VT
authors.lastname: Marteinsson
authors.affiliation: a Department of Urology , Landspitali University Hospital , Reykjavik, Iceland.
authors.forename: Eirikur
authors.initials: E
authors.lastname: Jonsson
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion
keywords: Bladder cancer; complications; radical cystectomy; survival