Surgical risks in radical cystectomy: experience of a specialized center

Background. Radical cystectomy is the standard treatment for muscle invasive bladder cancer. However, it is associated with a high risk of complications and mortality. Key strategies to reduce these risks include implementation of minimally invasive treatment methods and the Enhanced Recovery After Surgery (ERAS) protocol, as well as identification of factors associated with development of complications.

Aim. To analyze 30-day postoperative complications and mortality rates following radical cystectomy taking into account the effect of the ERAS protocol on treatment outcomes.

Materials and methods. This retrospective single-center cohort study included surgical treatment outcomes of 455 patients with a confirmed diagnosis of bladder cancer (cTis–4N0–3) who underwent radical cystectomy via either open or laparoscopic approaches. Of these, 344 patients (75.6 %) underwent perioperative rehabilitation following the ERAS principles. The severity of complications was assessed using the Clavien classification as modified by the European Association of Urology. The study protocol was approved by the Biomedical Ethics Committee (No. 32/355 from 23.12.2020).

Results. Surgeries in the ERAS group were more frequently performed using minimally invasive techniques (98.5 % vs. 62.2 %; p <0.001), with reduced blood loss and shorter operative times, and were more often accompanied by standard and extended lymphadenectomy (p <0.001). In the ERAS group, ileocecal angle mobilization was performed in 49.4 % of cases, significantly reducing the risk of mechanical and dynamic bowel obstruction by factor of 2.68 (p = 0.006). Median in-hospital time was 9 days shorter in the ERAS group (p <0.001), and overall complication rate was 40.7 % compared to 56.8 % in the standard care group (p = 0.003). Mortality rates did not differ between the groups (1.8 % vs. 2.3 %; p = 1.0).

Conclusion. The implementation of the ERAS protocol and minimally invasive techniques in radical cystectomy significantly reduces postoperative complication rates, including the risk of bowel obstruction, shortens hospital stays, and improves overall treatment outcomes.

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