Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort.
OBJECTIVE
Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control.


METHODS
We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery.


RESULTS
We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The médium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients.


CONCLUSIONS
In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Renato B
RB
Corradi
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Gustavo Jaime Climaco
GJ
Galvao
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Gabriel M
GM
Oliveira
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Vinicius F
VF
Carneiro
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Wadson Gomes
WG
Miconi
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Paulo Guilherme Oliveira
PG
Salles
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Walter Luiz Ribeiro
WL
Cabral
Departamento de Urologia, Hospital das Clínicas UFMG, Belo Horizonte, MG, Brasil.
Carlos
C
Corradi
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Andre Lopes Lopes
AL
Salazar
D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001938:Brazil; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010388:Pelvis; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*