Outcome of open radical cystectomy with pelvic lymph node dissection for bladder urothelial cancer in Siriraj hospital between 1998-2003
Keywords:
bladder cancer, open radical cystectomy, survival, complicationAbstract
Objective: To evaluate outcomes of open radical cystectomy (RC) with pelvic lymph node dissection (PLND) for muscle invasive bladder cancer including 5 - year overall survival, 5 - year cancer specific survival, and complications.
Material and methods: Database from 175 patients who underwent open RC with PLND for muscle invasive bladder cancer at division of Urology Siriraj Hospital between January 1998 to December 2003 were collected. Retrospective reviewed on patient characteristics, pathologic details of pre- and post cystectomy specimens, recurrence, survival status and immediate-late postoperative complications. Missing information was gathered from calls. Patientsû data with complete information were analyzed to assess 5-year overall survival, 5 -year cancer specific survival and immediate-late postoperative complication rates. Five year survival rate was determined using Kaplan-Meier survival curves and was categorized by pathological T stage, lymph nodes status and surgical marginal status.
Results: Of 140 urothelial muscle invasive cancer that underwent open RC with PLND patientsû files only 70 files were completely accepted for this study. Ninety percent was male gender and mean age was 63.1 years. Ninety seven percent was high grade urothelial cell carcinoma and pathological T stage was categorized including pT1, pT2, pT3, and pT4 was 5.7%, 35.7%, 41.4%, and 17.1%, respectively. Thirty percent of cases had lymph node metastasis (pT2, pT3, and pT4 had 1, 12, and 8 cases, respectively) and 5.7% had organ metastasis at the time of diagnosis. No case received neoadjuvant treatment. Mean follow up time was 5.4 years. Forty two cases were dead and the most cause of death was bladder cancer (48.6%). Five year overall survival and 5 year cancer specific survival was 50.0% and 59.2%, respectively. Pathological T stage, lymph node metastasis and positive surgical margin had effect to survival rate, significantly. Fourteen percent of cases had positive surgical margin and six cases were received adjuvant treatment. Most of urinary diversion was ileal conduit (54.3%). Nineteen cases (27.1%) had early postoperative complication, and the most complication was surgical wound infection.
Conclusions: RC with PLND remains the standard treatment of muscle invasive bladder cancer. Pathological T stage, lymph node metastasis, and positive surgical margin have significant impact on the survival outcome. Our study survival outcome was comparable to other series.
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