What are the possible complications of radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

In early 2009, the Memorial Sloan-Kettering Cancer Center reported a complication rate of 67% for 1,142 consecutive cystectomies. [26] Strict guidelines were used, and their results suggest that prior publications may have underestimated the true complication rate. Specifically, in 2006, the University of Southern California reported 28% complication and 2% mortality rates (primarily due to cardiovascular events, sepsis, and pulmonary embolism) in a series of 1,359 patients who underwent radical cystectomy. [2]

Common complications include ileus, atelectasis, DVT, and wound infection. Less common complications include rectal injury, ureteroileal anastomotic leaks, and bowel obstruction.

Lymphadenectomy typically carries a low morbidity rate. In a large series that detailed complication rates directly attributable to the lymph node dissection, about 5% of patients had prolonged lymphatic drainage via an externalized tube; however, all tubes were postoperatively removed within 10 days. Although an extended lymph node dissection typically takes approximately 60 minutes longer than a standard dissection, perioperative morbidity and mortality rates were not higher in a small series of 92 patients from Austria.

Rectal injury results from undue excessive traction of the specimen, which can cause tenting and avulsion of rectal tissue or direct incision into the rectum. If the rectum is injured, a meticulous multilayered repair using the Lembert technique is necessary. Suture a flap of peritoneum or omentum over the repaired injury and copiously irrigate. Perirectal drainage, length of nothing-by-mouth status, and duration of antibiotic therapy are case- and surgeon-dependent.


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