[Mortality and morbidity after total cystectomy for cancer]

The authors review mortality and morbidity in 100 consecutive patients who during a six year period underwent total cystectomy for carcinoma of the bladder. The postoperative mortality was 15 (15%), essentially as a result of septic and respiratory complications. In relation to the type of diversion: 6 deaths in 46 cases of cutaneous ureterostomy, 4 deaths amongst 19 cases of trans-intestinal cutaneous ureterostomy, 3 deaths amongst 24 cases of uretero-colic implantation and 2 deaths amongst 11 cases of replacement enterocystoplasty . Amongst factors involved in the cause of postoperative mortality, three appeared to be of essential importance: a very high anaesthetic class (class IV), defective drainage of dissected areas, sources of deep abscesses , and use of the intestine in the method of completing total cystectomy. In the last 40 cases, the use of cutaneous ureterostomy in 82.5% of cases and careful attention to drainage of the operative site led to a reduction in mortality to 5% (2/40) whilst in the first 60 cystectomies of the series, 68.3% of which were completed by ureterocolic implantation, mortality was 21.7% (13/60). Early and late complications were also much more frequent in diversion procedures using the intestine than after direct cutaneous ureterostomy. But after replacement enterocystoplasty , late complications were virtually nonexistent. The authors indicate the following guidelines as conclusions: - in patients who accept a cutaneous implant, direct cutaneous ureterostomy is the best bypass procedure.(ABSTRACT TRUNCATED AT 250 WORDS)