Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, Box 356510, Seattle, WA 98195, USA.
Cancer. 2010 Jan 15;116(2):331-9. doi: 10.1002/cncr.24763.
The rate of continent urinary diversion after radical cystectomy for bladder cancer varies by patient and provider characteristics. Demonstration of equivalent complication rates, independent of diversion type, may decrease provider reluctance to perform continent reconstructions. The authors sought to determine whether continent reconstructions confer increased complication rates after radical cystectomy.
From the Nationwide Inpatient Sample, the authors used International Classification of Disease (ICD-9) codes to identify subjects who underwent radical cystectomy for bladder cancer during 2001-2005. They determined acute postoperative medical and surgical complications from ICD-9 codes and compared complication rates by reconstruction type using the nearest neighbor propensity score matching method and multivariate logistic regression models.
Adjusting for case-mix differences between reconstructive groups, continent diversions conferred a lower risk of medical, surgical, and disposition-related complications that was statistically significant for bowel (3.1% lower risk; 95% confidence interval [95% CI], -6.8% to -0.1%), urinary (1.2% lower risk; 95% CI, -2.3%, to -0.4%), and other surgical complications (3.0% lower risk; 95% CI, -6.2% to -0.4%), and discharge other than home (8.2% lower risk; 95% CI, -12.1% to -4.6%) compared with ileal conduit subjects. Older age and certain comorbid conditions, including congestive heart failure and preoperative weight loss, were associated with significantly increased odds of postoperative medical and surgical complications in all subjects.
Mode of urinary diversion after radical cystectomy for bladder cancer is not associated with increased risk of immediate postoperative complications. These results may encourage broader consideration of continent urinary diversion without concern for increased complication rates.
膀胱癌根治性膀胱切除术后行可控尿流改道术的比例因患者和术者特征而异。证明不同尿流改道方式下具有相似的并发症发生率，可能会降低术者对行可控重建术的抵触。作者旨在确定膀胱癌根治性膀胱切除术后行可控重建术是否会增加并发症发生率。
作者通过国际疾病分类（ICD-9）代码，从全国住院患者样本中筛选 2001 年至 2005 年间行膀胱癌根治性膀胱切除术的患者。作者根据 ICD-9 代码确定术后急性医疗和手术并发症，并采用最近邻倾向评分匹配法和多变量逻辑回归模型比较不同重建类型的并发症发生率。
在调整重建组间病例特征差异后，与回肠膀胱术相比，可控尿流改道术具有更低的医疗、手术和处置相关并发症风险，其中肠道（风险降低 3.1%；95%置信区间 [95%CI]：-6.8%至-0.1%）、尿路（风险降低 1.2%；95%CI：-2.3%至-0.4%）和其他手术并发症（风险降低 3.0%；95%CI：-6.2%至-0.4%）以及非家庭出院（风险降低 8.2%；95%CI：-12.1%至-4.6%）的风险统计学显著降低。年龄较大和某些合并症（充血性心力衰竭和术前体重减轻）与所有患者的术后医疗和手术并发症风险显著增加相关。
膀胱癌根治性膀胱切除术后尿流改道方式与术后早期并发症风险增加无关。这些结果可能会鼓励更多地考虑可控尿流改道术，而不必担心并发症发生率增加。
