Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

Abstract

Introduction: Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. Materials and methods: A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. Results: Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35e89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type IIIa ( p ¼ 0.03). A longer operative time was an independent risk factor of CCS III (OR: 1.005; CI: 1.002e1.007 per minute; p ¼ 0.0001).

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

“…However, previous studies failed to show higher complication rates for advanced diseases compared to localized tumours. 2,3,5,7 Nonetheless, further investigations are needed to comprehensively address this issue. Additionally, the NSQIP database lacked information regarding gastrointestinal complications, which has been shown to occur in a substantial proportion of patients after RC.…”

“…Several studies have reported predictors of complications, perioperative mortality, and readmission. However, these data are usually obtained from tertiary referral centres, 2,[5][6][7] and therefore may not be generalizable to the American population. Recent population-based studies have reported nationwide outcomes for patients treated with RC for bladder cancer.…”

“…1 Despite refinements in surgical technique and perioperative management, RC has been associated with a substantial risk of postoperative morbidity and mortality, where the rates of short-term complications and mortality. [1][2][3][4][5][6][7] Identifying determinants of postoperative outcomes is crucial for individual risk-adjustment prior to RC. Several studies have reported predictors of complications, perioperative mortality, and readmission.…”

Measuring procalcitonin (PCT) levels: a pilot study in early diagnosis of patients affected by ureterocutaneostomy infection

“…Urinary infections represent one of the major complications in patients affected by UCS, crucially determining a decreasing of renal functionality over time [2]. An early diagnosis is fundamental to improve the prognosis and block the progression, hence, allowing for therapy [3,4].…”

Peri-Operative Outcomes after Open and Robot-Assisted Radical Cystectomy by Using an Advanced Bipolar Seal and Cut Technology (Caiman®): A Prospective, Comparative, and Multi-Institutional Study

“…Currently, open radical cystectomy (ORC) is still the gold standard approach, but a significant morbidity, high complication rate and mortality is still related to this technique [2,3,4]. More recently, robot-assisted radical cystectomy (RARC) has emerged as an attractive alternative to ORC, aiming to reduce morbidity and complications, and to potentially improve peri-operative and functional outcomes [5,6,7,8].…”