Radical Cystectomy and Urinary Diversion

Radical cystectomy with extended pelvic lymphadenectomy provides excellent local control of and long-term survival after muscle-invasive bladder cancer. Surgery cures most patients with muscleinvasive tumors that are confined to the bladder (stage pT2), about half of patients with extravesical disease (stage pT3-4), and a significant minority with pelvic lymph nodes that test positive for cancer. Surgery also allows accurate staging and provides important pathologic information to identify those patients in which disease is likely to recur.

Radical cystectomy remains, however, an aggressive procedure with significant morbidity and mortality. The surgery lasts several hours, the hospital stay and recovery period are prolonged, and fluid and electrolyte imbalances can develop. Because most patients diagnosed with invasive bladder cancer are old and many have multiple comorbidities, such a complex, lengthy procedure puts these patients at high risk of complications, with bowel complications the major cause of morbidity and mortality.