title: Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer.
abstract: OBJECTIVE
  To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy.
  
  
  METHODS
  In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months.
  
  
  RESULTS
  Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months.
  
  
  CONCLUSIONS
  Immediate surgical management seems feasible, safe, and efficacious.
authors.affiliation: Department of Surgical and Biochemical Sciences, Division of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Via Tristano di Joannuccio, 05100 Terni, Italy.
authors.forename: Giovanni
authors.identifier: 0000-0003-3982-2004
authors.initials: G
authors.lastname: Cochetti
authors.affiliation: Department of Surgical and Biochemical Sciences, Division of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Via Tristano di Joannuccio, 05100 Terni, Italy.
authors.forename: Francesco
authors.identifier: 0000-0002-8191-380X
authors.initials: F
authors.lastname: Barillaro
authors.affiliation: Department of Surgical and Biochemical Sciences, Division of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Via Tristano di Joannuccio, 05100 Terni, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Boni
authors.affiliation: Department of Surgical and Biochemical Sciences, Division of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Via Tristano di Joannuccio, 05100 Terni, Italy.
authors.forename: Ettore
authors.identifier: 0000-0003-1652-2965
authors.initials: E
authors.lastname: Mearini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery
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