Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press35410.17650/1726-9776-2010-6-4-42-46DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак мочевого пузыряPREDICTORS OF EARLY SEVERE COMPLICATIONS AFTER RADICAL CYSTECTOMYПРЕДИКТОРЫ РАННИХ ТЯЖЕЛЫХ ОСЛОЖНЕНИЙ РАДИКАЛЬНОЙ ЦИСТЭКТОМИИKrasnyS. A.КрасныйС. А.
Russian Federation
rolevich@tut.bySukonkoO. G.СуконкоО. Г.
Russian Federation
rolevich@tut.byPolyakovS. L.ПоляковС. Л.
Russian Federation
rolevich@tut.byRolevichA. I.РолевичА. И.
Russian Federation
rolevich@tut.byMinichA. A.МиничА. А.
Russian Federation
rolevich@tut.byMavrichevA. S.МавричевА. С.
Russian Federation
rolevich@tut.byVolkovA. N.ВолковА. Н.
Russian Federation
rolevich@tut.byMirilenkoL. V.МириленкоЛ. В.
Russian Federation
rolevich@tut.byN.N. Alexandrov Republican Research and Practice Center of Oncology and Medical Radiology, Minsk, Republic of BelarusГУ РНПЦ ОМР им. Н.Н. Александрова, Минск, Республика Беларусь301220106442460708201407082014https://oncourology.abvpress.ru/oncur/article/view/354

Background. Radical cystectomy (RC) with urinary diversion is one of the most traumatic operations in urologic oncology. This paper estimates the frequency and severity of complications due to successive series of RC and analyzes the predictors of serious events after surgery. Materials and methods. All cases of complications were selected from the medical records of 408 patients who had undergone RC with urinary diversion at the N.N. Alexandrov Research and Practice Center of Oncology and Medical Radiology in 1999 to 2008. The frequency of grades 3 to 5 complications was studied in relation to various variables, by applying the univariate logistic regression analysis. The multivariate analysis of the most important parameters was made. Odds ratios (OR), 95% confidence intervals (CI), and statistical significance (p) were calculated for all parameters. Results. A total of 132 complications were recorded in 91 (22%) patients. According to the severity of the disease, the complications were divided as follows: grades 1 [n=26 (20%)], 2 [n=39 (30%)], 3 [(n=48 (36%)], 4 [(n=5 (4%)], and 5 [(n=14 (10%)] complications. Body mass index > 25 (OR 2,62; 95% CI 1,23-5,55; p=0,012) and a surgeons experience (> 100 cystectomies) (OR 0,48; 95% CI 0,240-0,99; p=0,04) were of prognostic value in the multivariate analysis. Conclusion. A considerable number of complications were noted after RC with urinary diversion. The multivariate analysis has shown that overweight increases the risk of severe complications after surgery and a surgeons rich experience reduces it.

Введение. Радикальная цистэктомия (РЦЭ) с отведением мочи является одной из наиболее травматичных операций в онкоурологии. В данной работе оценена частота и тяжесть осложнений последовательной серии РЦЭ, а также проведен анализ факторов прогноза серьезных осложнений операции. Материалы и методы. Из медицинской документации больных, подвергнутых РЦЭ с отведением мочи в РНПЦ ОМР им. Н.Н. Александрова в 1999−2008 гг. (n=408), отобраны все случаи осложнений. Исследована частота осложнений III−V степени в зависимости от различных переменных с использованием монофакторного логистического регрессионного анализа. По наиболее значимым показателям проведен многофакторный анализ. Для всех показателей вычислены отношения шансов (ОР), 95% доверительные интервалы (ДИ) и статистическая значимость (p). Результаты. Всего зарегистрировано 132 осложнения у 91 (22%) больного. В зависимости от степени тяжести осложнения распределялись следующим образом: I степень - 26 (20%) осложнении, II степень - 39 (30%), III степень - 48 (36%), IV степень - 5 (4%), V степень - 14 (10%) осложнений. В мультивариантном анализе прогностическое значение имели индекс массы тела > 25 (OР 2,62; 95% ДИ 1,23-5,55; p=0,012) и опыт хирурга > 100 цистэктомий (OР 0,48; 95% ДИ 0,240-0,99; p=0,048). Выводы. После РЦЭ с отведением мочи отмечается существенное количество осложнений. Как показал мультивариантный анализ, наличие избыточной массы тела у больного повышает, а большой опыт хирурга - снижает риск тяжелых осложнений операции.

radical cystectomysevere complicationsrisk factorsclassification of the severity of complicationsрадикальная цистэктомиятяжелые осложненияфакторы рискаклассификация тяжести осложнений1. Stenzl A., Cowan N.C., De Santis M. et al. The updated EAU guidelines on muscleinvasive and metastatic bladder cancer. Eur Urol 2009;55:815–25.Stenzl A., Cowan N.C., De Santis M. et al. The updated EAU guidelines on muscleinvasive and metastatic bladder cancer. Eur Urol 2009;55:815–25.2. Buscarini M., Pasin E., Stein J.P. Complications of radical cystectomy. Minerva Urol Nefrol 2007;59:67–87.Buscarini M., Pasin E., Stein J.P. Complications of radical cystectomy. Minerva Urol Nefrol 2007;59:67–87.3. 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;240:205–13.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;240:205–13.4. Studer U.E., Burkhard F.C., Schumacher M. et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute–lessons to be learned. J Urol 2006;176(1):161–6.Studer U.E., Burkhard F.C., Schumacher M. et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute–lessons to be learned. J Urol 2006;176(1):161–6.5. 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):834–44.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):834–44.6. Donat S.M. Standards for surgical complication reporting in urologic oncology: time for a change. Urology 2007;69(2):221–5.Donat S.M. Standards for surgical complication reporting in urologic oncology: time for a change. Urology 2007;69(2):221–5.7. Martin R.C. 2nd, Brennan M.F., Jaques D.P. Quality of complication reporting in the surgical literature. Ann Surg 2002;235(6):803–13.Martin R.C. 2nd, Brennan M.F., Jaques D.P. Quality of complication reporting in the surgical literature. Ann Surg 2002;235(6):803–13.8. 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;55:164–76.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;55:164–76.9. 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.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):914–21.10. 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.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):929–34.11. Roth B., Huwyler M., Studer U.E. Closure of the dorsal peritoneal layer after cystectomy and extended pelvic lymphadenectomy (PLND) and its impact on the early postoperative recovery and postoperative complications: Results of a prospective randomized trial. Eur Urol Suppl 2009;8(4):1–16; abstr 724.Roth B., Huwyler M., Studer U.E. Closure of the dorsal peritoneal layer after cystectomy and extended pelvic lymphadenectomy (PLND) and its impact on the early postoperative recovery and postoperative complications: Results of a prospective randomized trial. Eur Urol Suppl 2009;8(4):1–16; abstr 724.12. Fisher M.B., Svatek R.S., Hegarty P.K. et al. Cardiac history and risk of post-cystectomy cardiac complications. Urology 2009;74(5):1085–9.Fisher M.B., Svatek R.S., Hegarty P.K. et al. Cardiac history and risk of post-cystectomy cardiac complications. Urology 2009;74(5):1085–9.13. Gore J.L., Yu H.Y., Setodji C. et al.; Urologic Diseases in America Project. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 2010;116(2):331–9.Gore J.L., Yu H.Y., Setodji C. et al.; Urologic Diseases in America Project. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 2010;116(2):331–9.14. Lee C.T., Dunn R.L., Chen B.T. et al. Impact of body mass index on radical cystectomy. J Urol 2004;172(4 Pt 1):1281–5.Lee C.T., Dunn R.L., Chen B.T. et al. Impact of body mass index on radical cystectomy. J Urol 2004;172(4 Pt 1):1281–5.