Mortality rate of last 100 cases of Radical Cystectomy

Abstract

Introduction: Recent years with perfection of surgical techniques, anesthesia and postoperative supervision, early postoperative mortality after radical cystectomy has considerably decreased. But risk factors of mortality were not studied sufficiently.

Materials and methods: Postoperative mortality cases defined as a death within 30 days after surgery are analyzed. For determining the causes of lethal outcomes we referred to the medical documentation of the given patients, estimated the risk factors of planned radical cystectomy and preparation to it, evaluated the techniques of cystectomy and types of anesthesia, analyzed the management of risk factors after radical cystectomy.

Results: Among 100 patients treated from 2002 to 2007 postoperative mortality was registered in 4 cases, of those 3 were male patients and 1 — female. Median age of patients who underwent cystectomy was 57 years (range 38—76). The median time from cystectomy to death was 24 days (range from 9 to 30). Lethal outcomes resulted from infectious factor, were the consequences of inter-intestinal anastomosis leak-age in 2 from 3 cases, necrosis of anterior abdominal wall in 1 patient. Presence of obesity, hydronephrosis and chronic renal insufficiency (high serum creatinine) in combination with anemia significantly increases the risk of development of interintestinal anastomosis leakage.

Fatal pulmonary embolism confirmed on autopsy is noted in 1 of postoperative death cases. The patient suffered from obesity with a body mass index of 30 and had varicose vein disease of the lower extremities al illness of the lower limbs. Besides, he was a heavy smoker (35 cigarettes per day). Lethal outcome from thromboembolism of pulmonary artery occurred on 9 day after cystectomy.

Conclusions: Retrospective character of the given review allows drawing conclusions concerning contributing factors to mortality rate. Selection of candidates for cystectomy, detailed studying of the anamnesis and concomitant pathology in combination with improving anesthesia and surgical techniques as well as the careful control of the postoperative period management with maintenance of necessary standard approaches considerably reduces the development rate of dangerous complications which results in a reduction of mortality rate.