Ileal Conduit and Cystectomy: A 10-Year Retrospective Study of Ileal Conduits Performed in Conjunction with Cystectomy and with a Minimum 5-Year Followup
A 10-year retrospective study was done on 55 patients with primary carcinoma of the bladder who underwent cystectomy with ileal conduit urinary diversion. The 5-year survival rate was 52 per cent for patients with stages O, A and Bl tumors, 45 per cent for those with stages B2 and C tumors and 0 per cent for those with stage D tumors. Patients with squamous cell carcinoma had the worst prognosis, with no patients surviving more than 2 years.
Operative mortality rate was 8.9 per cent and all deaths occurred in patients undergoing radical cystectomy and pelvic lymphadenectomy. The operative mortality in this group was 16 per cent, versus no mortality in 24 patients undergoing simple cystectomy. Since no patient with positive pelvic nodes lived more than 20 months postoperatively there appears to be little justification in recommending routine pelvic lymphadenectomy in patients with operable bladder carcinoma.
We believe that preoperative radiation added to the morbidity rate and increased the incidence of urinary leakage. Since 80 per cent of the patients who died (4 of 5) had massive pulmonary emboli low dose heparin prophylaxis should be considered in all patients undergoing cystectomy in whom intraoperative bleeding is not a problem.
