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A Critical Analysis of Perioperative Mortality From Radical Cystectomy

2006; Lippincott Williams & Wilkins; Volume: 175; Issue: 3 Linguagem: Inglês

10.1016/s0022-5347(05)00421-0

1527-3792

Marcus L. Quek, John P. Stein, Siamak Daneshmand, Gus Miranda, Duraiyah Thangathurai, Peter Roffey, Eila C. Skinner, Gary Lieskovsky, Donald G. Skinner,

Urological Disorders and Treatments

No AccessJournal of UrologyAdult urology1 Mar 2006A Critical Analysis of Perioperative Mortality From Radical Cystectomy Marcus L. Quek, John P. Stein, Siamak Daneshmand, Gus Miranda, Duraiyah Thangathurai, Peter Roffey, Eila C. Skinner, Gary Lieskovsky, and Donald G. Skinner Marcus L. QuekMarcus L. Quek Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , John P. SteinJohn P. Stein Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , Siamak DaneshmandSiamak Daneshmand Division of Urology, Oregon Health & Science University, Portland, Oregon Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , Gus MirandaGus Miranda Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , Duraiyah ThangathuraiDuraiyah Thangathurai Departments of Urology and Anesthesiology, USC/Norris Comprehensive Cancer Center, Los Angeles, California Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , Peter RoffeyPeter Roffey Departments of Urology and Anesthesiology, USC/Norris Comprehensive Cancer Center, Los Angeles, California Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , Eila C. SkinnerEila C. Skinner Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , Gary LieskovskyGary Lieskovsky Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California , and Donald G. SkinnerDonald G. Skinner Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00421-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Operative mortality from radical cystectomy has decreased as a result of improvements in surgical and anesthetic care. We reviewed the perioperative deaths from a large group of patients treated with radical cystectomy for primary bladder cancer. Materials and Methods: All perioperative mortalities from radical cystectomy were identified from a single high volume institution. The medical records were reviewed to assess the cause of death as well as possible contributing factors. Results: From August 1971 to December 2001, 1,359 patients with primary bladder cancer were treated with radical cystectomy and pelvic iliac lymphadenectomy at our institution. Of these patients, 27 (2%) died within 30 days of surgery or before discharge from hospital. Median patient age at surgery was 67 years (range 47 to 78) and males accounted for 81% of the patients. The median time to death was 28 days from cystectomy (range 0 to 80). Most deaths were cardiovascular related (including acute myocardial infarction, cerebrovascular accident, arterial thrombosis) or due to septic complications with resulting multi-organ system failure, followed by pulmonary embolism, hepatic failure and hemorrhage. Septic related mortality was most often associated with postoperative urine or bowel leak. While most deaths occurred before hospital discharge, 2 patients died at home due to a late pulmonary embolus. No association was seen between pathological stage or type of urinary diversion and mortality. Conclusions: Perioperative mortality from radical cystectomy is low in this group of patients. Most deaths are due to cardiovascular or septic complications. Careful patient selection and meticulous surgical technique may help decrease the incidence of perioperative mortality. References 1 : Cystectomy and urinary diversion. J Urol1966; 96: 714. Link, Google Scholar 2 : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol2001; 19: 666. Google Scholar 3 : The changing pattern of mortality and morbidity from radical cystectomy. BJU Int2000; 85: 427. 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Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byPariser J, Pearce S, Anderson B, Packiam V, Prachand V, Smith N and Steinberg G (2018) Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous HeparinJournal of Urology, VOL. 197, NO. 2, (302-307), Online publication date: 1-Feb-2017.Forrest J (2018) Editorial CommentaryUrology Practice, VOL. 3, NO. 6, (466-467), Online publication date: 1-Nov-2016.VanDlac A, Cowan N, Chen Y, Anderson R, Conlin M, La Rochelle J, Amling C and Koppie T (2018) Timing, Incidence and Risk Factors for Venous Thromboembolism in Patients Undergoing Radical Cystectomy for Malignancy: A Case for Extended Duration Pharmacological ProphylaxisJournal of Urology, VOL. 191, NO. 4, (943-947), Online publication date: 1-Apr-2014.Boorjian S, Kim S, Tollefson M, Carrasco A, Cheville J, Thompson R, Thapa P and Frank I (2018) Comparative Performance of Comorbidity Indices for Estimating Perioperative and 5-Year All Cause Mortality Following Radical Cystectomy for Bladder CancerJournal of Urology, VOL. 190, NO. 1, (55-60), Online publication date: 1-Jul-2013.Sterious S, Simhan J, Uzzo R, Gershman B, Li T, Devarajan K, Canter D, Walton J, Fogg R, Ginzburg S, Corcoran A, Smaldone M and Kutikov A (2018) Familiarity and Self-Reported Compliance with American Urological Association Best Practice Recommendations for Use of Thromboembolic Prophylaxis among American Urological Association MembersJournal of Urology, VOL. 190, NO. 3, (992-998), Online publication date: 1-Sep-2013.Davis J, Gaston K, Anderson R, Dinney C, Grossman H, Munsell M and Kamat A (2018) Robot Assisted Extended Pelvic Lymphadenectomy at Radical Cystectomy: Lymph Node Yield Compared With Second Look Open DissectionJournal of Urology, VOL. 185, NO. 1, (79-84), Online publication date: 1-Jan-2011.Kokorowski P, Routh J, Borer J, Estrada C, Bauer S and Nelson C (2018) Screening for Malignancy After Augmentation Cystoplasty in Children With Spina Bifida: A Decision AnalysisJournal of Urology, VOL. 186, NO. 4, (1437-1443), Online publication date: 1-Oct-2011.Pillai P, McEleavy I, Gaughan M, Snowden C, Nesbitt I, Durkan G, Johnson M, Cosgrove J and Thorpe A (2018) A Double-Blind Randomized Controlled Clinical Trial to Assess the Effect of Doppler Optimized Intraoperative Fluid Management on Outcome Following Radical CystectomyJournal of Urology, VOL. 186, NO. 6, (2201-2206), Online publication date: 1-Dec-2011.Hautmann R, de Petriconi R and Volkmer B (2018) Lessons Learned From 1,000 Neobladders: The 90-Day Complication RateJournal of Urology, VOL. 184, NO. 3, (990-994), Online publication date: 1-Sep-2010.Stimson C, Chang S, Barocas D, Humphrey J, Patel S, Clark P, Smith J and Cookson M (2018) Early and Late Perioperative Outcomes Following Radical Cystectomy: 90-Day Readmissions, Morbidity and Mortality in a Contemporary SeriesJournal of Urology, VOL. 184, NO. 4, (1296-1300), Online publication date: 1-Oct-2010.Forrest J, Clemens J, Finamore P, Leveillee R, Lippert M, Pisters L, Touijer K and Whitmore K (2018) AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic SurgeryJournal of Urology, VOL. 181, NO. 3, (1170-1177), Online publication date: 1-Mar-2009.Isbarn H, Jeldres C, Zini L, Perrotte P, Baillargeon-Gagne S, Capitanio U, Shariat S, Arjane P, Saad F, McCormack M, Valiquette L, Peloquin F, Duclos A, Montorsi F, Graefen M and Karakiewicz P (2018) A Population Based Assessment of Perioperative Mortality After Cystectomy for Bladder CancerJournal of Urology, VOL. 182, NO. 1, (70-77), Online publication date: 1-Jul-2009.Svatek R, Avritscher E, Elting L and Dinney C (2018) High Risk Populations and Cystectomy OutcomesJournal of Urology, VOL. 182, NO. 1, (10-11), Online publication date: 1-Jul-2009.Novara G, De Marco V, Aragona M, Boscolo-Berto R, Cavalleri S, Artibani W and Ficarra V (2018) Complications and Mortality After Radical Cystectomy for Bladder Transitional Cell CancerJournal of Urology, VOL. 182, NO. 3, (914-921), Online publication date: 1-Sep-2009.Barbieri C, Lee B, Cookson M, Bingham J, Clark P, Smith J and Chang S (2018) Association of Procedure Volume With Radical Cystectomy Outcomes in a Nationwide DatabaseJournal of Urology, VOL. 178, NO. 4, (1418-1422), Online publication date: 1-Oct-2007. Volume 175Issue 3March 2006Page: 886-890 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsurinary diversionmortalitycystectomypostoperative complicationsbladder neoplasmsMetricsAuthor Information Marcus L. Quek Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author John P. Stein Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Siamak Daneshmand Division of Urology, Oregon Health & Science University, Portland, Oregon Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Gus Miranda Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Duraiyah Thangathurai Departments of Urology and Anesthesiology, USC/Norris Comprehensive Cancer Center, Los Angeles, California Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Peter Roffey Departments of Urology and Anesthesiology, USC/Norris Comprehensive Cancer Center, Los Angeles, California Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Eila C. Skinner Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Gary Lieskovsky Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Donald G. Skinner Keck School of Medicine at the University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Expand All Advertisement PDF downloadLoading ...