Year 2018 Vol. 26 No 4

UROLOGY

.. RYNDZIN, L.. ZAITSEVA, I.F. SHISHLO, A.V. POLUJANCHIK, S.A. KRASNY

PREDICTION OF SEVERE POSTOPERATIVE COMPLICATIONS OF RADICAL CYSTECTOMY

N.N. Alexandrov National Cancer Center of Belarus, Minsk,
The Republic of Belarus

Objective. To access the predictors and structure of the postoperative Clavien-Dindo grade ≥3 complications in the bladder cancer patients after the radical cystectomy (RC) and to create the model to predict the likelihood of such complications.
Methods. Results of the radical cystectomy series performed in N.N. Alexandrov National Cancer Center of Belarus during the period from 1999 to 2012 (849 patients) were retrospectively analyzed. The information about postoperative Clavien-Dindo grade ≥3 complications during 30 days after the radical cystectomy was obtained from medical records. By means of uni- and multivariate logistic regression analyses, the relationship of severe postoperative complications with perioperative parameters was assessed.
Results. Postoperative complications were registered in 351 patients from 849 (41%). 116 patients had 128 Clavien-Dindo grade ≥3 complications (13.7%, 95% CI 11.4-16.0). Multivariate regression analysis revealed the statistically significant correlation of complications frequency of Clavien-Dindo grade ≥3 with the following factors: surgeons experience (<50 versus >200 RC: OR 3.252; 95% CI 1.297-8.157; p=0.011; 50-200 versus >200 RC: OR 2.61; 95% CI 1,456-4,89; p=0.002), patients age (<70 versus ≥70: OR 1.779; 95% CI 0.125-2.815; p=0.014), body mass index (BMI) (<25 versus ≥25: OR 1.779; 95% CI 1.117-2.821; =0.04), previous open bladder surgery (OR 3.479; 95% CI 1.055-11.409; =0.015), preoperative serum creatinine level (<155 mmol/l versus ≥155 mmol/l, OR 2.762, 95% CI 1.415-5.388; p=0.003).
Conclusions. Complication rate is influenced by patients parameters (BMI ≥25, age ≥70 and serum creatinine level ≥155 mmol/l) and surgeon experience, which should be taken into account before planning radical cystectomies.

Keywords: urinary bladder neoplasms, radical cystectomy, severe complications, complication grade classification, prognosis
p. 447-456 of the original issue
References
  1. Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014 Apr;65(4):778-92. doi: 10.1016/j.eururo.2013.11.046
  2. Buscarini M, Pasin E, Stein JP. Complications of radical cystectomy. Minerva Urol Nefrol. 2007 Mar;59(1):67-87. https://www.minervamedica.it/en/journals/minerva-urologica-nefrologica/article.php?cod=R19Y2007N01A0067
  3. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009 Jan;55(1):164-74. doi: 10.1016/j.eururo.2008.07.031
  4. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae
  5. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-96. doi: 10.1097/SLA.0b013e3181b13ca2
  6. Kursa MB, Rudnicki WR. Feature selection with the boruta package. J Stat Soft. 2010;36(11):1-13. doi: 10.18637/jss.v036.i11
  7. Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, Thalmann GN. Twenty years experience with an ileal orthotopic low pressure bladder substitutelessons to be learned. J Urol. 2006 Jul;176(1):161-66. doi: 10.1016/S0022-5347(06)00573-8
  8. Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002 Jun;235(6):803-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422509/
  9. Novara G, De Marco V, Aragona M, Boscolo-Berto R, Cavalleri S, Artibani W, Ficarra V. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009 Sep;182(3):914-21. doi: 10.1016/j.juro.2009.05.032
  10. Svatek RS, Fisher MB, Matin SF, Kamat AM, Grossman HB, Nogueras-González GM, Urbauer DL, Kennedy KA, Dinney CP. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol. 2010 Mar;183(3):929-34. doi: 10.1016/j.juro.2009.11.038
  11. Fisher MB, Svatek RS, Hegarty PK, McGinniss JE, Hightower C, Grossman HB, Kamat AM, Dinney CP, Matin SF. Cardiac history and risk of post - cystectomy cardiac complications. Urology. 2009;74(5):1085-89. doi: 10.1016/j.urology.2009.04.103
  12. Krasnyi SA, Sukonko OG, Poliakov SL, Rolevich AI, Minich AA, Mavrichev AS, Volkov AN, Mirilenko LV. Prediktory rannikh tiazhelykh oslozhnenii radikalnoi tsistektomii. Onkourologiia. 2010;(4):42-46. http://oncourology.abvpress.ru/oncur/issue/view/34/showToc (in Russ.)
  13. Ahmed K, Khan SA, Hayn MH, Agarwal PK, Badani KK, Balbay MD, Castle EP, Dasgupta P, Ghavamian R, Guru KA, Hemal AK, Hollenbeck BK, Kibel AS, Menon M, Mottrie A, Nepple K, Pattaras JG, Peabody JO, Poulakis V, Pruthi RS, Redorta JP, Rha KH, Richstone L, Saar M, Scherr DS, Siemer S, Stoeckle M, Wallen EM, Weizer AZ, Wiklund P, Wilson T, Woods M, Khan MS. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014 Feb;65(2):340-47. doi: 10.1016/j.eururo.2013.09.042
  14. Lee CT, Dunn RL, Chen BT, Joshi DP, Sheffield J, Montie JE. Impact of body mass index on radical cystectomy. J Urol. 2004 Oct;172(4 Pt 1):1281-85. doi: 10.1097/01.ju.0000138785.48347.aa
  15. Moschini M, Simone G, Stenzl A, Gill IS, Catto J. Critical Review of Outcomes from Radical Cystectomy: Can Complications from Radical Cystectomy Be Reduced by Surgical Volume and Robotic Surgery? Eur Urol Focus. 2016 Apr;2(1):19-29. doi: 10.1016/j.euf.2016.03.001
Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy-1,
N.N. Alexandrov National Cancer
Center of Belarus,
Oncourological Unit,
Tel. mobile: +375 29 667-09-10,
e-mail: aryndzin@gmail.com,
Aliaksei A. Ryndzin
Information about the authors:
Ryndzin Aliaksei A., Urologist, the Oncourological Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus
http://orcid.org/0000-0001-5642-8397
Zaitseva Lidya A., Junior Researcher of the Carcinogenesis Laboratory of the Diagnostic Department, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-8004-1942
Shishlo Iosif F., PhD, Oncologist-Surgeon, the Hepatopancreatobiliary Pathology Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3114-3974
Poluyanchik Andrei V., PhD, Head of the Operative Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0718-1548
Krasny Sergey A., MD, Professor, Corresponding Member of NAS of RB, Deputy Director for Research, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3244-5664
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