Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database

Abstract

Objective: To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types. Materials and Methods: We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratifi ed by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD). Results: When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p<0.001) and without RC (34.0% vs 22.0%, p=0.032). Conclusions: RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.

Perioperative mortality for radical cystectomy in the modern Era: experience from a tertiary referral center

“…The primary treatment for muscle-invasive and selected high-risk non-invasive urothelial bladder carcinoma (UBC) is radical cystectomy (RC) which is required in about a third of bladder cancer patients ( 3 ). RC remains to be one of the most complicated urological procedures, with a considerable rate of morbidity and postoperative complications ( 4 , 5 ). There is a noteworthy rate of mortality for RC according to the National Cancer Data Base (NCDB), reporting the 30- and 90-day mortality rates to be 2.7% and 7.2% overall, and 1.9% and 5.7% in high-volume institutions, respectively ( 6 ).…”

Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration

“…Anastomotic and PR time were 14 (range 7-20) and 5 minutes ( 4 – 8 ), respectively. No intra-operative complications were recorded.…”

“…Even if bladder sparing strategies are challenging the role of surgery ( 1 , 3 ), technical and technological advances are making the surgical procedure less invasive. RC is a complex procedure that may involve the combined surgery of the urinary and gastrointestinal tract ( 4 – 6 ). It can be performed either open, laparoscopically and robotically; current EAU Guidelines suggest that no approach is over another.…”

The effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of radical cystectomy with ileal conduit urinary diversion

“…Although the majority of the post-RC complications are minor, it has been reported that up to 20% of patients will experience a major complication (23,24). Multiple studies reported that more common complication categories are gastrointestinal, infectious, wound-related, and genitourinary (12,25).…”