Peri‐operative morbidity and mortality related to radical cystectomy: a multi‐institutional retrospective study in Japan

Abstract

What ' s known on the subject? and What does the study add?Radical cystectomy remains associated with comparatively high perioperative morbidity and mortality, despite improvements in surgical techniques and perioperative care. At present, most studies on the complications associated with open radical cystectomy were derived from Western academic high-volume centres, and data from Japan and other Asian countries were very limited.Using the modifi ed Clavien grading system and 11 category grouping reported from MSKCC, we observed that 68% of patients experienced at least one complication within 90 days of surgery, and 17% of patients experienced major complications (90-day mortality rate = 2%), which were compatible with reports from Western high-volume centres. As far as we know, our report is the largest one regarding perioperative morbidity and mortality in Asian patients who underwent radical cystectomy. OBJECTIVE• To determine the type, incidence and severity of 90-day morbidity after radical cystectomy in our institution and our affi liated hospitals in accordance with a standard reporting methodology. A t present, most studies on complications associated with open radical cystectomy are derived from W estern academic high-volume centres and data from J apan and other A sian countries remain very limited. PATIENTS AND METHODS• The study comprised a retrospective multi-institutional study.• The records were reviewed of 928 patients who underwent open radical cystectomy between 1997 and 2010.• All complications within 90 days of surgery were categorized into 11 specifi c categories and graded in accordance with the modifi ed C lavien system.• Multivariate regression models were used to determine predictors of complications. RESULTS• A t least one complication was observed in 635 (68%) patients and a major (grade 3-5) complication was observed in 156 (17%) patients.• The most common complication categories were infectious (30%), gastrointestinal (26%), wound-related (21%) and genitourinary (15%).• The 30-day mortality rate was 0.8% and the 90-day mortality rate was 2%.• A multivariate regression model showed that previous cardiovascular comorbidity and type of urinary diversion (i.e. ileal conduit or neobladder) were signifi cant factors for any and major complications. CONCLUSIONS• Surgical complication-related radical cystectomy is signifi cant and both previous cardiovascular comorbidity and the type of urinary diversion were found to be signifi cant factors for any and major complications.• The 90-day mortality rate was 2%, which is compatible with reports from Western high-volume centres.

Postoperative mortality and complications after radical cystectomy for bladder cancer in Quebec: A population-based analysis during the years 2000-2009

“…Moreover, it is our opinion that measuring 90-day mortality is more relevant than 30-day mortality since improvements in postoperative care may postpone surgery-related deaths beyond 30 days. 16 Supporting this point, Shabsigh and colleagues found that 45% of RC-related deaths occurred between 30 and 90 days and would not have been reported in the traditional 30-day time period. 4 Our mortality rates at 30, 60 and 90 days were 2.8%, 5.3% and 7.5%, respectively; these rates are considered high when compared with recent literature and reports from around the world.…”

Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥75 years after radical cystectomy for treatment of bladder cancer

“…One reason for the lower use of RC for elderly patients might be that RC frequently causes complications. Takada et al [11] evaluated [12] reported an overall incidence of complications of 64 % and an incidence of major complications of 13 %. In our study the overall incidence of complications was 34.3 % and the incidence of severe complications was 16.5 % (Table 2).…”

Editorial Comment to Use of sigmoid colon in orthotopic neobladder reconstruction: Long‐term results

“…4,5 Regarding the continence rate, they observed 45% complete continence (daytime and night-time), and 36% daytime continence only. Because "daytime continence only" probably means daytime continence + night-time incontinence, approximately 80% of patients would have "daytime continence," being consistent with previous observations.…”

“…2,3 Furthermore, they reported a low early complication rate of 22.6% compared with previous studies, although they did not provide the details of postoperative management. 4,5 Regarding the continence rate, they observed 45% complete continence (daytime and night-time), and 36% daytime continence only. Because "daytime continence only" probably means daytime continence + night-time incontinence, approximately 80% of patients would have "daytime continence," being consistent with previous observations.…”