Info

Death

1-3%

Source: Cancer Control ©2002 H Lee Molfi tt Cancer Center and Research Institute, Inc.

Source: Cancer Control ©2002 H Lee Molfi tt Cancer Center and Research Institute, Inc.

various complications may occur during both the early and late postoperative period. It is important to know the factors that can increase the risk for complications: age, American Society of Anaesthesiologists score, pre-operative haemoglobin, smoking history, prior abdominal surgeries or external-beam radiation therapy, and type of diversion. Overall, the rate of minor complications for patients undergoing radical cystectomy is approximately 30% (Table 5).

Results

The significant improvements in clinical outcomes over the past 25 years can be attributed to advances in surgical technique and in medical and anaesthetic care.23,25

Overall, recurrence-free and survival rates vary among institutions.25 Less than 50% of patients with locally advanced or node-positive bladder cancer will survive if treated by surgery (cystectomy) alone.25,26

Recently, Herr et al. reviewed a cystectomy series in over 2,000 patients.35 The 10-year relapse-free survival rate was 77% with pathologic organ-confined tumours, 44% with extravesical tumours and 34% in cases with positive lymph nodes.

However, the larger series have agreed that higher pathological stage and increased lymph-node status are generally associated with increased recurrence rates and worse cancer-specific survival.25,26,35-40 Overall, radical cystectomy for invasive bladder cancer offers an approximate 60-70% five-year disease-free survival rate.26 Subdivided, this percentage can increase to higher than 70% for organ-confined lymph-node-negative bladder tumours and decrease to 40-50% for those patients with non-organ-confined lymph-node-positive bladder tumours (Figures 1 and 2).26,36 This latter group consistently demonstrates higher rates for recurrence and worse survival compared to those with organ-confined disease.25,26,35-40

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