Corradi Renato B, Galvao Gustavo Jaime Climaco, Oliveira Gabriel M, Carneiro Vinicius F, Miconi Wadson Gomes, Salles Paulo Guilherme Oliveira, Cabral Walter Luiz Ribeiro, Corradi Carlos, Salazar Andre Lopes Lopes
Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil.
Departamento de Urologia, Hospital das Clínicas UFMG, Belo Horizonte, MG, Brasil.
Int Braz J Urol. 2016 May-Jun;42(3):431-7. doi: 10.1590/S1677-5538.IBJU.2015.0380.
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.
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.
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.
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.
根治性膀胱切除术（RC）联合盆腔淋巴结清扫术是肌层浸润性膀胱癌的标准治疗方法，其肿瘤学结局与疾病病理及手术技术直接相关。因此，我们试图分析巴西一家三级肿瘤中心队列中的这些特征，并试图找出那些可能对疾病控制产生负面影响的因素。
我们确定了2009年1月至2012年7月期间在一家肿瘤学三级转诊公共中心（巴西贝洛奥里藏特的马里奥·彭纳研究所）接受根治性膀胱切除术以治疗膀胱癌的128例患者。我们回顾性分析了从他们的病理报告中获得的结果，并评估了手术后30天内的并发症。
与文献中的其他大型系列研究相比，我们的病理和手术结果相似，然而我们的患者中pT4期疾病的发生率略高。128例患者中有2例（1.5%）发现手术切缘阳性。清扫的淋巴结中位数为15个。膀胱切除术后30天内发生的主要并发症（Clavien 3至5级）在33/128例（25.7%）患者中出现。
在浸润性膀胱癌的治疗中，应努力专注于疾病的正确诊断和分期，然后根据病理结果进行正确治疗。此外，所有有RC指征的患者都应进行扩大的淋巴结清扫术。在未来的研究中对我们的并发症进行批判性分析将有助于我们识别和改变一些与手术发病率相关的因素。
