透析患者接受不含尿液分流術之根除性膀胱切除手術有較少之早期併發症
楊昀達、林承家、陳文祥、黃賢祥、林政鋒、吳俊德
基隆長庚醫院 外科部 泌尿科
Less Early Complications of Radical Cystectomy in Hemodialysis Patients without Urinary Diversion
Yun-Ta Yang, Cheng-Chia Lin, Wen-Hsiang Chen, Shian-Shiang Huang, Cheng-Feng Lin, Chun-Te Wu
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
Purpose:
End-stage renal disease patients under dialysis were thought as high risk group for anesthesia and operation, as well more complications post-operatively. However, for an anuria patient with bladder cancer who is going to receive radical cystectomy surgery, urinary diversion is not necessary, which made radical cystectomy a practical choice. This study aimed to compare oncologic outcomes and early complications between dialysis patients and general complication with bladder cancer.
Materials and Methods:
This study included 85 patients confirmed as primary urothelial cell carcinoma of bladder. All of the patients received radical cystectomy surgery in Chang Gung Memorial Hospital, between April 1, 2006, and March 31, 2016. Among these patients, 28 patients with ESRD received dialysis regularly. Overall survival and recurrence-free survival were compared for oncologic outcomes evaluation. Three-months complications were graded with the Clavien-Dindo classification.
Results:
Among the ESRD patients, the overall 5-year survival rate were 75%, and 55% in non-ESRD patients, while without a statistic significance (P=0.276). The recurrence-free survival rate were 53% and 47% (P=0.528), respectively. The overall complication rate were 36% and 84% in ESRD and non-ESRD groups (P<0.001). The major complications (Grade III-V) rate were 16% in ESRD and 28% in non-ESRD (P=0.241). The most common early complications were from gastrointestinal tract and infection. Further, gastrointestinal tract complication and urinary tract infection rates were both significant lower in ESRD group.
Conclusion:
Despite dialysis often lead to a dismal outcomes in stereotype, lower early complication rates and non-inferior oncologic outcomes were observed in the study. In confront with a dialysis patient with indication of radical cystectomy, surgeon could be more confidence to conduct aggressive intervention in suitable case.