Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer

الملخص EN

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.