Thirty-day complications of radical cystectomy and factors that influence their development

Objective: to identify the most important factors influencing the development of complications after radical cystectomy (RCE).

Materials and methods. The results of 182 RCEs performed in September 2014 and December 2016 were analyzed. The patients included 152 (83.5 %) men and 30 (16.5 %) women. The patients’ age ranged from 31 to 84 years (mean age 62.3 years). An orthotopic urinary reservoir was formed in 138 (75.8 %) patients. Postoperative complications were evaluated according to the Clavien–Dindo classification. The calculations were made with a computer program for SPSS Statistics 16.

Results. No complications were recorded in 84 (46.2 %) patients within 30 days after RCE. The development of various postoperative adverse reactions was observed in 98 (53.8 %) patients. The most common complications were gastrointestinal (26.9 %) and infectious (25.8 %). Sixteen (8.8 %) patients developed grade I complications; grades II, III, IV, and V complications were seen in 53 (29.1 %), 21 (11.5 %), 5 (2.7 %), in 3 patients, respectively. Thirty-day mortality was 1.64 %. Univariate regression analysis has established that overweight (p = 0.031), T status (p = 0.021), preoperative hemoglobin levels (p = 0.001), intraoperative blood loss (p = 0.009), and intraoperative abdominal cavity infection (p <0.001) play a significant role in the development of complications following RCE. Multivariate regression analysis has revealed that the frequency of complications after RCE is influenced by body mass index (p = 0.008), preoperative anemia (p = 0.034), blood loss (p = 0.003), and intraoperative abdominal cavity infection (p <0.001).

Conclusion. RCE is often accompanied by the development of different categories and severity of complications. Identification of risk factors for their complications will be able to elaborate effective ways for their prevention.

1. Shabsigh A., Korets R., Vora K. C. et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009;55(1):164–76. DOI: 10.1016/j.eururo. 2008.07.031. PMID: 18675501.

2. Атдуев В. А., Мамедов Х. М. Раневые осложнения после радикальной цистэктомии. Урология 2011;(5):89–91. [Atduev V. A., Mamedov Kh. M. Wound complications after radical cystectomy. Urologiya = Urology 2011;(5):89–91 (In Russ.)].

3. Перепечай В. А., Васильев О. Н., Спицын И. М., Коган М. И. Предикторы морбидности радикальной цистэктомии и различных вариантов уродеривации: 20-летний опыт одного хирургического центра. Онкоурология 2016;12(1):42–57. [Perepechai V. A., Vasilyev O. N., Spitsyn I. M., Kogan M. I. Predictors for morbidity of radical cystectomy and different types of urine derivation: 20-year experience of a surgery center. Onkourologiya = Cancer Urology 2016;12(1):42–57. (In Russ.)]. DOI: http://dx.doi.org/10.17650/1726-9776-2016-12-1-42-57.

4. Novara G., De Marco V., Aragona M. et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 2009;182(3):914–21. DOI: 10.1016/j.juro.2009.05.032. PMID: 19616246.

5. Hautmann R.E., de Petriconi R. C., Volkmer B. G. Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol 2010;184(3):990–4. DOI: 10.1016/j.juro.2010.05.037. PMID: 20643429.

6. Svatek R. S., Fisher M. B., Matin S. F. et al. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol 2010;183(3):929–34. DOI: 10.1016/j.juro.2009.11.038. PMID: 20083264.

7. Lawrentschuk N., Colombo R., Hakenberg O. W. et al. Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol 2010;57(6):983– 1001. DOI: 10.1016/j.eururo.2010.02.024. PMID: 20227172.

8. Bostrom P. J., Kossi J., Laato M., Nurmi M. Risk factors for mortality and morbidity related to radical cystectomy. BJU Int 2009;103(2):191–6. DOI: 10.1111/j. 1464-410X.2008.07889.x. PMID: 18671789.

9. Комяков Б. К., Горелов С. И., Новиков А. И. и др. Ближайшие результаты радикальных цистэктомий. Урология 2003;(4):15–8. [Komyakov B. K., Gorelov S. I., Novikov A. I. The nearest results of radical cystectomies. Urology = Urologiya 2003;(4):15–8. (In Russ.)].

10. Chang S. S., Cookson M. S., Baumgartner R. G. et al. Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol 2002;167(5):2012–6. PMID: 11956429.

11. Pycha A., Comploj E., Martini Т. et al. Comparison of complications in three incontinent urinary diversions. Eur Urol 2008;54(4):825–32. DOI: 10.1016/j.eururo.2008.04.068. PMID: 18502026.

12. Hautmann R. E., de Petriconi R., Gottfried H. W. et al. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 1999;161(2):422–7. PMID: 9915417.

13. Шаплыгин Л. В., Ситников Н. В., Фурашов Д. В. и др. Радикальная цистэктомия в лечении инвазивного рака мочевого пузыря. Военный медицинский журнал 2003; (12):43–6. [Shaplygin L. V., Sitnikov N. V., Furashov D. V. et al. Radical cystectomy in the treatment of invasive bladder cancer. Voennyy meditsinskiy zhurnal = Military Medical Journal 2003;(12):43–6. (In Russ.)].

14. Коган М. И., Васильев О. Н., Перепечай В. А. Послеоперационные осложнения: роль в выживаемости больных после радикальной цистэктомии и их влияние на послеоперационную летальность. Медицинский вестник Юга России 2014;(4):58–64. [Kogan M. I., Vasil’ev O.N., Perepechay V. A. Postoperative complications: role in survival of patients after radical cystectomy and their impact on postoperative mortality. Meditsinskiy vestnik Yuga Rossii = Medical Gazette of the South of Russia 2014;(4):58–64. (In Russ.)].

15. Morgan T. M., Keegan K. A., Barocas D. A. et al. Predicting the probability of 90-day survival in elderly bladder cancer patients treated with radical cystectomy. J Urol 2011;186(3):829–34. DOI: 10.1016/j.juro.2011.04.089. PMID: 21788035.

16. Dindo D., Demartines N., Clavien P. A. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–13. PMID: 15273542.

17. Hollenbeck B. K., Daignault S., Dunn R. L. et al. Getting under the hood of the volume- outcome relationship for radical cystectomy. J Urol 2007;177(6):2095–9. DOI: 10.1016/j.juro.2007.01.153. PMID: 17509295.

18. Stimson C. J., Chang S. S., Barocas D. A. et al. Early and late perioperative outcomes following radical cystectomy: 90-day readmissions, morbidity and mortality in a contemporary series. J Urol 2010;184(4):1296–300. DOI: 10.1016/j.juro.2010.06.007. PMID: 20723939.

19. Game X., Soulie M., Seguin P. et al. Radical cystectomy in patients older than 75 years: assessment of morbidity and mortality. Eur Urol 2001;39(5):525–9. DOI: 52498. PMID: 11464032.

20. Clark P. E., Stein J. P., Groshen S. G. et al. Radical cystectomy in the elderly: comparison of clinical outcomes between younger and older patients. Cancer 2005;104(1): 36–43. DOI: 10.1002/cncr.21126. PMID: 15912515.

21. Nieuwenhuijzen J. A., de Vries R. R., Bex A. et al. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions. Eur Urol 2008;53(4):834–42. DOI: 10.1016/j.eururo.2007.09.008. PMID: 17904276.

22. Ballestero Diego R., Rebollo Rodrigo H., Gutierrez Banos J. L. et al. Nosocomial infection and infection of the surgical site in a third level hospital: 2002–2005. Actas Urol Esp 2006;30(9):905–12. PMID: 17175930.

23. Hara N., Kitamura Y., Saito T. et al. Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: efficacy and risk of antimicrobial prophylaxis on the operation day alone. Int J Urol 2008;15(6):511–5. DOI: 10.1111/j.1442–2042.2008.02050.x. PMID: 18422576.

24. Takeyama K., Matsukawa M., Kunishima Y. et al. Incidence and risk factors for surgical site infection in patients with radical cystectomy with urinary diversion. J Infect Chemother 2005;11(4):177–81. DOI: 10.1007/s10156-005-0391-1. PMID: 16133708.

25. Yamamoto S., Kunushima Y., Kanamaru S. et al. A multi-center prospective study for antibiotic prophylaxis to prevent perioperative infections in urologic surgery. Hiniokika Kiyo 2004;50(10):673–83. PMID: 15575217.

26. Harraz A. M., Osman Y., El-Halwagy S. et al. Risk factors of hospital readmission after radical cystectomy and urinary diversion: analysis of a large contemporary series. BJU Int 2015;115(1):94–100. DOI: 10.1111/bju.12830. PMID: 24905239.

27. Osawa T., Ambani S., Olugbade K. Jr et al. Potential implications of shortening length of stay following radical cystectomy in a Pre-ERAS population. Urology 2017;102:92–9. DOI: 10.1016/j.urology. 2016.10.051. PMID: 28013038.

28. Wittig K., Ruel N., Barlog J. et al. Critical analysis of hospital readmission and cost burden after robot-assisted radical cystectomy. J Endourol 2016;30(1):83–91. DOI: 10.1089/end.2015.0438. PMID: 26405852.

29. Khan M. S., Elhage O., Challacombe B. et al. Analysis of early complications of robotic- assisted radical cystectomy using a standardized reporting system. Urology 2011;77(2):357– 62. DOI: 10.1016/j.urology.2010.04.063. PMID: 20828801.

30. Mangram A. J., Horan T. C., Pearson M. L. et al. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999;20(4):247–78. DOI: 10.1086/501620. PMID: 10219875.

31. Health Protection Agency. Surveillance of surgical site infection in England: October 1997 – September 2005. London: Health Protection Agency, 2006. 123 p.

32. Lowrance W. T., Rumohr J. A., Chang S. S.et al. Contemporary open radical cystectomy: analysis of perioperative outcomes. J Urol 2008;179(4):1313–8. DOI: 10.1016/j.juro.2007.11.084. PMID: 18289578.

33. Novotny V., Hakenberg O. W., Wiessner D. et al. Perioperative complications of radical cystectomy in a contemporary series. Eur Urol 2007;51(2):397–401. DOI: 10.1016/j.eururo.2006.06.014. PMID: 16905242.

34. Cookson M. S., Chang S. S., Wells N. et al. Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J Urol 2003;169(1):101–4. DOI: 10.1097/01.ju.0000039521.77948.f9. PMID: 12478113.

35. Pariser J. J., Pearce S. M., Anderson B. B. et al. Extended duration enoxaparin decreases the rate of venous thromboembolic events after radical cystectomy compared with inpatient only subcutaneous heparin. J Urol 2017;197(2):302–7. DOI: 10.1016/j.juro.2016.08.090. PMID: 27569434.

36. Golhaber S. Z. Risk factors of venous thromboembolism. J Am Coll Cardiol 2010;56(1): 1– 7. DOI: 10.1016/j.jacc.2010.01.057. PMID: 20620709.

37. Атдуев В. А., Шутов В. В., Березкина Г. А. и др. Результаты создания артифициального мочевого пузыря после радикальной цистэктомии у больных раком мочевого пузыря. Медицинский альманах 2009;3(8): 114–8. [Atduev V. A., Shutov V. V., Berezkina G. A. et al. The results of creating an official bladder after radical cystectomy in patients with bladder cancer. Meditsinskiy al’manakh = Medical Almanac 2009;3(8):114–8. (In Russ.)].

38. Urinary diversion. Bladder cancer. Eds.: M. Soloway, S. Khoury. International Consultation on Bladder Cancer. Vienna. 2nd Edn. 2012. Pp. 343–378.