Medicinski vjesnik, Vol. 37 No. (1-4), 2005.
Professional paper
Radical surgical treatment of urinary bladder cancer: our experiences
Anton Maričić
Željko Fučkar
Gianpaolo Velčić
Petar Orlić
Miomir Zelić
Damir Dimec
Maksim Valenčić
Romano Oguić
Vladimir Mozetič
Stanislav Sotošek
Abstract
In the period from 1972-2004, 1708 patients with bladder cancer were treated. 239 (14 %) of them were treated by means of radical surgical procedures. There were 188 (78.7%) male and 51 (21.3%) female patients. The average age was between 60 and 80 (171 71.5%). The most frequent and the most important symptom of bladder cancer is hematuria 213 (89%). In our patients there were 220 (92%) epithelial cancers, 13 (5.4%) planocellular cancers and 6 (2.5%) adenocarcinomas. According to TNM classification, T3 stage (118 - 49.3%) and T2 stage (94- 39.3%) were predominant in our study. According to histological criteria, the most common was G3 stage (186 -77.8%). Radical cystectomy alone or combined with urethrectomy was done in 203 (85%) patients. Unfortunately, in 13% of patients (T3b and T4 stages) inner iliac blood vessels were tied off due to a progressive cancer. Outer supravesicular urine derivation (Bricker, U-tubing nephrostoma) was done in 188 (78.7%) patients. Inner derivation (Coffey, uretheroileosigmoidostomy, Mainz-Pouch II) was done in 23 (9.6%) and neovesica (Hautmann, Studer) in 28 (11.7%) patients. There were 83 (34.7 %) early postoperative complications. Among them the most dominant ones were surgical 32 (13.4%) and distant organ complications 23 (9.6%). Among late complications, predominant ones were uroinfection 11 (4.6%) and ileus 8 (3.3%), which were treated conservatively. In the patients with negative nodes 72 (30%), the survival rate after five years was 62%. In the patients with positive nodes 59 (24.6%), the survival rate after five years was 44%. The least favorable prognosis was for patients (13%) in whom cystectomy could not be done due to a progressive process. In these patients, iliac blood vessels were tied off and they were treated with radiotherapy and chemotherapy. The survival rate was 9% after one year.
Keywords
Internal derivation; Neovesica; Radical cystectomy; Ureteroileocutaneostomy-Bricker; Urinary bladder cancer - radical surgical treatment
Hrčak ID:
190873
URI
Publication date:
1.12.2005.
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