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International Journal of Clinical Oncology

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01-08-2018 | Original Article

Complications within 90 days after radical cystectomy for bladder cancer: results of a multicenter prospective study in Japan

Authors: Megumi Hirobe, Toshiaki Tanaka, Tetsuya Shindo, Koji Ichihara, Hiroshi Hotta, Atsushi Takahashi, Ryuichi Kato, Masahiro Yanase, Masanori Matsukawa, Naoki Itoh, Yasuharu Kunishima, Keisuke Taguchi, Hiroki Horita, Naoya Masumori

Published in: International Journal of Clinical Oncology | Issue 4/2018

Abstract

Purpose

We prospectively evaluated the 90-day postoperative mortality and morbidity of open radical cystectomy by using a standardized reporting methodology. Additionally, we assessed the preoperative characteristics to determine risk factors for major complications.

Methods

This multicenter prospective study included 185 consecutive patients undergoing open radical cystectomy from October 2010 through March 2014. Postoperative complications within 90 days were recorded and graded according to the modified Clavien–Dindo classification.

Results

Totally, 328 postoperative complications were observed in 149 patients (80.5%). Of these events, 73 (22.2%) were high grade (≥ Grade III), and developed in 46 patients (24.9%). Three patients (1.6%) died postoperatively. Urinary tract infection, wound complications, and paralytic ileus were common complications that occurred in 55 (29.7%), 42 (22.7%) and 41 (22.2%) patients, respectively. Ureteroenteric stricture was diagnosed in 13 of the 151 patients (8.6%) undergoing intestinal urinary diversion. Emergency room visits were required for 13 patients (7.0%) and readmission after discharge was needed for 36 (19.5%). A body mass index ≥ 25 kg/m², smoking history and Charlson Comorbidity Index ≥ 2 were independent risk factors for high-grade complications, and their odds ratios (95% confidence intervals) were 2.357 (1.123–4.948), 2.843 (1.225–6.596) and 3.025 (1.390–6.596), respectively.

Conclusions

Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.

Rosario DJ, Becker M, Anderson JB (2000) The changing pattern of mortality and morbidity from radical cystectomy. BJU Int 85:427–430CrossRefPubMed

Chang SS, Cookson MS, Baumgartner RG et al (2002) Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol 167:2012–2016CrossRefPubMed

Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55:164–176CrossRefPubMed

Svatek RS, Fisher MB, Matin SF et al (2010) Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol 183:929–934CrossRefPubMed

Mayr R, May M, Martini T et al (2012) Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder. BJU Int 110:E222–E227CrossRefPubMed

Takada N, Abe T, Shinohara N et al (2012) Peri-operative morbidity and mortality related to radical cystectomy: a multi-institutional retrospective study in Japan. BJU Int 110:E756–E764CrossRefPubMed

Abdollah F, Sun M, Schmitges J et al (2012) Development and validation of a reference table for prediction of postoperative mortality rate in patients treated with radical cystectomy: a population-based study. Ann Surg Oncol 19:309–317CrossRefPubMed

Aziz A, May M, Burger M et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66:156–163CrossRefPubMed

Roghmann F, Trinh QD, Braun K et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21:143–149CrossRefPubMed

10.

Novotny V, Froehner M, Koch R et al (2016) Age, American Society of Anesthesiologists physical status classification and Charlson score are independent predictors of 90-day mortality after radical cystectomy. World J Urol 34:11231129CrossRef

11.

Lawrentschuk N, Colombo R, Hakenberg OW et al (2010) Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol 57:983–1001CrossRefPubMed

12.

Martin RCG, Brennan MF, Jaques DP (2002) Quality of complication reporting in the surgical literature. Ann Surg 235:803–813CrossRefPubMedPubMedCentral

13.

Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic co-morbidity in longitudinal-studies—development and validation. J Chronic Dis 40:373–383CrossRefPubMed

14.

Schmid M, Rink M, Traumann M et al (2015) Evidence from the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)’ Study: how are preoperative patient characteristics associated with urinary diversion type after radical cystectomy for bladder cancer? Ann Surg Oncol 22:1032–1042CrossRefPubMed

15.

Fairey A, Chetner M, Metcalfe J et al (2008) Associations among age, comorbidity and clinical outocomes after radical cystectomy; results from the Alberta Urology Institute Radical Cystectomy Database. J Urol 180:128–134CrossRefPubMed

16.

Lee CT, Dunn RL, Chen BT et al (2004) Impact of body mass index on radical cystectomy. J Urol 172:1281–1285CrossRefPubMed

17.

Svatek RS, Fisher MB, Williams MB et al (2010) Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology 76:1419–1424CrossRefPubMed

18.

Ramirez JA, McIntosh AG, Strehlow R et al (2013) Definition, incidence, risk factors, and prevention of paralytic ileus following radical cystectomy: a systematic review. Eur Urol 64:588–597CrossRefPubMed

19.

Mullen JT, Davenport DL, Hutter MM et al (2008) Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 15:2164–2172CrossRefPubMed

20.

de Blacam C, Ogunleye AA, Momoh AO et al (2012) High body mass index and smoking predict morbidity in breast cancer surgery a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg 255:551–555CrossRefPubMed

21.

Large MC, Cohn JA, Kiriluk KJ et al (2013) The impact of running versus interrupted anastomosis on ureterointestinal stricture rate after radical cystectomy. J Urol 190:923–927CrossRefPubMed

22.

Richards KA, Cohn JA, Large MC et al (2015) The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy. Urol Oncol 33(65):e1–e8

23.

Fawcett A, Shembekar M, Church JS et al (1996) Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study. Gut 38:714–718CrossRefPubMedPubMedCentral

24.

Sorensen LT, Jorgensen T, Kirkeby LT et al (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931CrossRefPubMed

25.

Abe T, Takada N, Shinohara N et al (2014) Comparison of 90-day complications between ileal conduit and neobladder reconstruction after radical cystectomy: a retrospective multi-institutional study in Japan. Int J Urol 21:554–559CrossRefPubMed

26.

Kim SH, Yu A, Jung JH et al (2014) Incidence and risk factors of 30-day early and 90-day late morbidity and mortality of radical cystectomy during a 13-year follow-up: a comparative propensity-score matched analysis of complications between neobladder and ileal conduit. Jpn J Clin Oncol 44:677–685CrossRefPubMed

27.

Novara G, De Marco V, Aragona M et al (2009) Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 182:914–921CrossRefPubMed

28.

Novara G, Catto JWF, Wilson T et al (2015) Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol 67:376–401CrossRefPubMed

29.

Khan MS, Gan C, Ahmed K et al (2016) A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol 69:613–621CrossRefPubMed

30.

Nix J, Smith A, Kurpad R et al (2010) Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 57:196–201CrossRefPubMed

31.

Bochner BH, Dalbagni G, Sjoberg DD et al (2015) Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol 67:1042–1050CrossRefPubMed

32.

Donat SM (2007) Standards for surgical complication reporting in urologic oncology: time for a change. Urology 69:221–225CrossRefPubMed

Title: Complications within 90 days after radical cystectomy for bladder cancer: results of a multicenter prospective study in Japan
Authors: Megumi Hirobe
Toshiaki Tanaka
Tetsuya Shindo
Koji Ichihara
Hiroshi Hotta
Atsushi Takahashi
Ryuichi Kato
Masahiro Yanase
Masanori Matsukawa
Naoki Itoh
Yasuharu Kunishima
Keisuke Taguchi
Hiroki Horita
Naoya Masumori
Publication date: 01-08-2018
Publisher: Springer Japan
Published in: International Journal of Clinical Oncology / Issue 4/2018
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-018-1245-z

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Abstract

Purpose

Methods

Results

Conclusions

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