THE LATE RESULTS OF ILEAL CONDUIT DIVERSION
WITH A SPECIAL REFERRENCE TO THE SURVIVAL RATES ON BLAADER MALIGNANCIES
1975 Volume 66 Issue 8 Pages 493-509
Details
1975 Volume 66 Issue 8 Pages 493-509
The late results on 105 patients who underwent ileal loop diversion at the Keio University Hospital and the afiliated hospitals during the period of 1966 to 1974 were reviewed. Radical cystectomy was carried out in most of the cases together with the conduit diversion. The age varied 5 to 77 and of the 105 patients, 79 were male and 26 were female, with the sex ratio of 3 to 1.
Actual survival rates from the 105 cases were 80.3% for one year, 69.4% for two years, 60.7% for three years, 54.8% for four years and 52.8% for five years.
Eighty-six cases of bladder malignancies were evaluated for stage and grade classifications. Actual survival rate of the patients with low grade transitional cell carcinomas (grade 1 and 2) was 73.2% for five years, while in those with high grade transitionnal cell carcinomas (grade 3 and 4) the rate was 33.5%. The five year survival rates according to the stage were 85.5% in stage A, 62.4% in stage B-1, 35.7% in stage B-2, 25.0% in stage C and 13.5% in stage D. In TNM classification, the survival rates were 85.5% in P-1, 62.4% in P-2, 31.8% in P-3 and 13.5% in P-4.
The prognosis of bladder cancer patients depends on radicality at the time of surgery. Five year survival rate in patients who underwent radical cystectomy together with ileal conduit diversion was 78.0% in stages A and B-1, and 41% in stages B-2 and C. On the other hand, the patients who underwent simple cystectomy and ileal conduit or the diversion only showed poor prognosis despite the postoperative radiation and chemotherapy.
Early complications such as wound infection, fistula, intestinal obstruction were seen in 15.2% of the cases. Only one operative death (1.0%) was due to gastrointestinal bleeding. Peristomal dermatitis (9.5%) was most common as late complications. It is emphasized that postoperative rehabilitation clinic consisted of doctors, nurses and paramedical personals can eliminate the patient's distress and fear in their daily life with urinary devices.
