Reporting perioperative complications of radical cystectomy: the influence of using standard methodology based on ICARUS and EAU quality criteria

Abstract

Purpose We aimed to evaluate perioperative complications of radical cystectomy (RC) by using standardized methodology. Additionally, we identified independent risk factors associated with perioperative complications. Materials and methods We retrospectively analyzed 30-day and 90-day perioperative complications of 211 consecutive RC patients. The intraoperative and postoperative complications were defined according to Clavien-Dindo classification (CDC) and reported based on the ICARUS criteria, Martin, and EAU quality criteria. Age-adjusted Charlson comorbidity index (ACCI), systemic inflammatory response index (SIRI), body mass index (BMI) ≥ 25 kg/m2, and neoadjuvant chemotherapy (NAC) were also evaluated. Multivariable regression models according to severe (CDC ≥ IIIb grade) complications were tested. Results Overall, 88.6% (187/211) patients experienced at least one intraoperative complication. Bleeding during cystectomy was the most common complication observed (81.5% [172/211]). Severe intraoperative complications (EAUiaiC grade > 2) were recorded in 8 patients. Overall, 521 postoperative complications were recorded. Overall, 69.6% of the patients experienced complications. Thirty-nine patients suffered from most severe (CDC ≥ IIIb grade) complications. ACCI (OR: 1.492 [1.144–1.947], p = 0.003), SIRI (OR: 1.279 [1.029–1.575], p = 0.031), BMI (OR: 3.62 [1.58–8.29], p = 0.002), and NAC (OR: 0.342 [0.133–0.880], p = 0.025) were significant independent predictive factors for 90-day most severe complications (CDC ≥ IIIb grade). Conclusions RC complications were reported within a standardized manner, concordant with the ICARUS and Martin criteria and EAU guideline recommendations. Complication reporting seems to be improved with the use of standard methodology. Our results showed that ACCI, SIRI, and BMI ≥ 25 kg/m2 and the absence of NAC were significant predictive factors for most severe complications.

Effectiveness of Preoperative Immunonutrition in Improving Surgical Outcomes after Radical Cystectomy for Bladder Cancer: Study Protocol for a Multicentre, Open-Label, Randomised Trial (INu-RC)

“…We estimate an expected absolute reduction of 17% in the complication rate or patients receiving preoperative IMN compared to patients receiving preoperative standard ONS. Postoperative complications following RC are known to occur in approximately 64–70% of patients without nutritional supplementation [ 4 , 18 ]. A small randomised pilot study showed a 30-day complication rate of around 73% in patients receiving standard ONS [ 19 ].…”

Perioperative factors and 30-day major complications following radical cystectomy: A single-center study in Thailand

“…Additionally, the following reported inflammatory-nutrition biomarkers were calculated based on the preoperative blood tests: Neutrophil-to-lymphocyte ratio (NLR) [ [9] , [10] , [11] ]. Platelet-to-lymphocyte ratio (PLR) [ 9 , 10 , 12 , 13 ]. Systemic inflammation response index (SIRI) [ 13 ], and Prognostic nutritional index (PNI) [ [13] , [14] , [15] ].…”

Patient experience of bladder cancer: A data linkage study

“…2 Side effects are related to treatment selection ranging from adverse reactions to chemotherapy and radiotherapy, to intraand post-operative complications associated with surgery. 3,4 Despite the high incidence, relatively little is known about patient experience of bladder cancer, as highlighted in a recent systematic review. 5 However, this information is important when helping patients to select management options and should also guide improvements to patient care pathways.…”

“…Management strategies typically include endoscopic resection, radiotherapy, chemotherapy, immunotherapy and radical surgical approaches such as cystectomy 2 . Side effects are related to treatment selection ranging from adverse reactions to chemotherapy and radiotherapy, to intra‐ and post‐operative complications associated with surgery 3,4 …”

“… 2 Side effects are related to treatment selection ranging from adverse reactions to chemotherapy and radiotherapy, to intra‐ and post‐operative complications associated with surgery. 3 , 4 …”