Medical uses and Malignancy - Cystectomy is the surgical removal of all or part of the urinary bladder. - The most common condition warranting cystectomy is bladder cancer. - Cystectomy is recommended for bladder cancer that has invaded the muscle of the bladder. - Cystectomy may be recommended for individuals with a high risk of cancer progression or failure of other treatments. - Radical cystectomy is the recommended treatment for bladder cancer that has invaded the muscle of the bladder. - Radical cystectomy involves removal of the entire bladder, surrounding lymph nodes, and nearby organs containing cancer. - Pathological cancer staging is determined through evaluation of the tissue removed during cystectomy. - Cancer staging helps determine further work-up, treatment, follow-up, and potential prognosis.

Types - Factors considered when determining the type of cystectomy include age, overall health, bladder function, type, location, and stage of cancer. - Partial cystectomy involves removal of a portion of the bladder and is performed for benign and localised malignant tumors. - Candidates for partial cystectomy include those with single tumors near the top of the bladder, non-muscle invasive tumors, tumors within bladder diverticulum, or cancer not carcinoma in situ (CIS). - Radical cystectomy is most commonly performed for cancer invading into the muscle of the bladder. - Radical cystectomy involves removal of the entire bladder, surrounding lymph nodes, and other organs containing cancer.

Technique - Open radical cystectomy involves a large incision in the abdomen, removal of the bladder, and potential removal of the prostate or other organs. - Pelvic lymph node dissection is performed during open radical cystectomy. - Minimally invasive radical cystectomy, such as robot-assisted laparoscopic cystectomy, involves small incisions and the use of surgical robots. - Minimally invasive cystectomy may require fewer blood transfusions and shorten hospital stay compared to open surgery. - There may be little to no difference in major complications, quality of life, recurrence, and cancerous cells left behind between robotic and open surgery.

Risks and complications - Radical cystectomy with urinary diversion carries risks of anaesthesia, bleeding, blood clots, heart attack, stroke, pneumonia, and infection. - Infection can occur at the surgical incision sites, urinary tract, abdomen, and gastrointestinal tract. - Complications following cystectomy include ileus (slow movement within intestines), intestinal obstruction, and leakage at reconnection sites. - Urinary tract complications can include ureter obstruction, requiring additional procedures for drainage. - Partial cystectomy carries risks of ureter damage and urine leakage.

Recovery - Diet before and after surgery: - No food or drink immediately after surgery - Diet gradually advances to liquids and then solid foods - Complications may slow down diet progression - Additional nutrition may be beneficial for those with eating difficulties - Immuno-enhancing nutrition may decrease complications - Pain control: - Intravenous pain medication used immediately after surgery - Switch to oral pain medication once diet is tolerated - Activity: - Early activity encouraged after surgery - Walking and sitting in a chair may be possible on the same day - Walking around the room or hospital ward within a day or two - Some individuals may require assistance or physical therapy - Venous thromboembolism prevention: - Compression devices or medications used before and after surgery - Heparin or low molecular weight heparin commonly used - VTE prophylaxis may continue after hospital discharge if needed - Surgery follow-up: - Staples removed 5 to 10 days after open cystectomy - Follow-up with surgeon scheduled 4 to 6 weeks after surgery - Laboratory or imaging studies may be done for assessment - Further care and follow-up determined during the visit