Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer
Giovanni Cochetti1, Francesco Barillaro1, Andrea Boni1
1Department of Surgical and Biochemical Sciences, Division of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Via Tristano di Joannuccio, 05100 Terni, Italy.
Objective:
To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy.
Materials And 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.
