Complications of radical cystectomy for carcinoma of the bladder.

A total of 165 consecutive patients underwent radical cystectomy for bladder cancer, 19 patients without preoperative radiation therapy, 109 patients after planned preoperative radiation therapy and 37 patients after failure of definitive radiation therapy (salvage cystectomy). The operative mortality was 2.4 per cent of the entire group: less than 1 per cent of the 128 patients undergoing cystectomy as primary treatment and 8.1 per cent of the 37 patients undergoing salvage cystectomy. Early complications occurred in 28 per cent of the 165 patients and included wound infeciton, urine leak, ureterointestinal obstruction, small bowel obstruction, intestinal leak, rectal fistual and/or medical complications. Postoperative hospitalization for those patients suffering any complication averaged 27 days compared to the average hospitalization of 12.7 days when no complications occurred. Selective use of the initial perineal approach in male patients who had received more than 6,000 rad and of staged cystectomy after urinary diversion in some high risk patiens, associated with salvage cystectomy, can reduce the postoperative mortality and morbidity significantly. The addition of a meticulous pelvic iliac lymph node dissection did not increase the operative mortality or morbidity compared to simpler procedures. Results of this study support the early aggressive use of single stage radical cystectomy with pelvic iliac lymph node dissection and urinary diversion in the management of patients with bladder cancer.