Surgical complications of radical cystectomy in a teaching hospital
We reviewed the surgical complications in 112 consecutive patients who had undergone radical cystectomy for bladder cancer at Tygerberg Hospital between 1978 and 1989. The cystectomies were performed by a total of 16 surgeons, of whom 1 (A) performed 30 and assisted at 2, 1 (B) performed 26 and assisted at 4, 2 (C+D) performed 27 and assisted at 16, and 12 (E-P) performed 29 and assisted at 46. Pre-operative radiotherapy was given in 37% of cases and intravesical chemotherapy in 25%. Major coexisting medical problems were present in 60%. The overall peri-operative mortality rate was 11%, but the rate was significantly lower (3%) in the group of patients operated on by surgeon A than in those operated on by surgeons E-P (21%). Major early postoperative complications occurred in 17% of the patients and major late complications in 25%. There were no significant differences between the different surgical groups in early and late complication rates. Peri-operative mortality and major early complications were significantly increased in patients aged over 71 years compared with those aged under 60 years. Peri-operative mortality was significantly increased in patients who had not received pre-operative radiotherapy compared with those who had done so. The presence of major coexistent medical problems did not significantly affect the rates of peri-operative mortality or major early or late surgical complications. Peri-operative mortality was lower in patients with T0-1 tumours than in those with T2-4 tumours, but the stage did not affect the incidence of major early or late surgical complications. Mortality and morbidity were not increased in patients who had undergone pelvic lymphadenectomy. Our study indicates that peri-operative mortality after radical cystectomy is significantly increased in cases of surgeons with limited experience performing the operation, in patients over 71 years old, in those who have not received preoperative radiotherapy, and in those with locally advanced tumours.