Abstract
Purpose
To examine postoperative complications after radical cystectomy (RC) and creation
of an ileum conduit (IC) or a neobladder (NB), and to identify preoperative risk factors
in a contemporary series of bladder cancer patients.
Patients and Methods
The study relied on prospectively collected data for 842 patients, who underwent inpatient
rehabilitation (IR) after RC and urinary diversion (IC n = 447, NB n = 395) between
April 2018 and December 2019. Postoperative complications until the end of IR were
assessed according to the Clavien-Dindo classification. Uni- and multivariate analyses
were performed to identify predictors for complications.
Results
A total of 2689 complications occurred in 813 patients (96.6%). High-grade complications
occurred more frequently before IR onset (25.5% vs. 5.7%; P < .001), whereas a higher percentage of low-grade complications occurred during IR
(89.0% vs. 77.8%; P < .001). The most common complication categories were genitourinary (60.9%), infectious
(54.0%) and gastrointestinal (49.2%). Rates of high-grade complications do not differ
between IC and NB patients (26.8% vs. 31.6%, P = .126). Independent predictors for overall complications were NB (odds ratio [OR]
21.520; P < .001), age ≥70 years (OR 2.522; P = .027) and higher body mass index (OR 1.153, P = .008). Risk factors for high-grade complications were NB (OR 1.448; P = .039) and Charlson Comorbidity Index ≥2 (OR 1.999; P = .001). Hospital readmission rate was 9.4%.
Conclusion
Our study revealed significantly higher overall and high-grade complication rates
after RC with IC or NB creation than previously published. A high percentage of low-grade
complications occur after hospital discharge. The hospital readmission rate was lower
compared to historical data.
Keywords
Abbreviations:
RC (radical cystectomy), IC (ileum conduit), NB (neobladder), IR (inpatient rehabilitation), CDC (Clavien-Dindo classification), CCI (Charlson Comorbidity Index), BMI (body mass index), IQR (interquartile range), CI (confidence interval), OR (odds ratio)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline.J Urol. 2017; 198: 552-559
- EAU guidelines on muscle-invasive and metastatic bladder cancer.in: European Association of Urology Guidelines. 2018 Edition. Vol presented at the EAU Annual Congress Copenhagen 2018. Arnhem, The Netherlands: European Association of Urology Guidelines Office; 2018. 2018
- ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion.Eur Urol. 2013; 63: 67-80
- Complications and mortality after radical cystectomy for bladder transitional cell cancer.J Urol. 2009; 182: 914-921
- Perioperative complications and mortality after radical cystectomy when using a standardized reporting methodology.Clin Genitourinary Cancer. 2013; 11: 189-197
- Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy.Intl J Urol. 2014; 21: 143-149
- Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.Eur Urol. 2009; 55: 164-174
- 90-Day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study.World J Urol. 2017; 35: 907-911
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications.World J Urol. 2017; 35: 1223-1231
- Readmissions after major urologic cancer surgery.Canadian J Urol. 2014; 21: 7537-7546
- Causes of hospital readmissions after urologic cancer surgery.Urologic oncology. 2016; 34 (e231-211)
Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF). S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms, Langversion 2.0. AWMF-Registrierungsnummer 032/038OL, Available at: https://www.leitlinienprogramm-onkologie.de/leitlinien/harnblasenkarzinom/ Accessed: July 27, 2020.2020.
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Quality of complication reporting in the surgical literature.Ann Surg. 2002; 235: 803-813
- Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations.Eur Urol. 2012; 61: 341-349
- Perioperative complications after neoadjuvant chemotherapy and radical cystectomy for bladder cancer.The Canadian J Urol. 2014; 21: 7259-7265
- Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial.Lancet (London, England). 2018; 391: 2525-2536
- Influence of body mass index on clinical outcome parameters, complication rate and survival after radical cystectomy: evidence from a Prospective European Multicentre Study.Urol Int. 2018; 101: 16-24
- Association between development of metabolic acidosis and improvement of urinary continence after ileal neobladder creation.J Urol. 2020; 203: 585-590
- Acid-base disorders after orthotopic bladder replacement: comparison of an ileal neobladder and an ileal conduit.Renal Failure. 2017; 39: 379-384
- The impact of socioeconomic status on perioperative complications and oncologic outcomes in patients undergoing radical cystectomy.World J Urol. 2017; 35: 1063-1071
- Perioperative outcomes after radical cystectomy at NCI-designated centres: are they any better?.Canadian Urol Assoc J. 2015; 9: 207-212
- Effect of hospital and surgeon case volume on perioperative quality of care and short-term outcomes after radical cystectomy for muscle-invasive bladder cancer: results from a european tertiary care center cohort.Clin Genitourinary Cancer. 2017; 15: e809-e817
- Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort.Eur Urol. 2014; 66: 156-163
Article Info
Publication History
Published online: May 19, 2022
Accepted:
May 17,
2022
Received in revised form:
May 12,
2022
Received:
December 2,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
