Department of Urology, Memorial Sloan-Kettering Cancer, New York, NY 10021, USA.
Urol Oncol. 2010 Jan-Feb;28(1):112-7. doi: 10.1016/j.urolonc.2009.04.012.
Gender differences in perioperative complications following radical cystectomy (RC) are under-studied, but suggest a tendency for higher blood loss and/or transfusion in females. Variability in reporting methodologies may affect findings; therefore, we utilized a standardized reporting methodology to evaluate for gender differences in perioperative complications at a tertiary cancer center.
A retrospective review of the Memorial Sloan-Kettering Cancer Center (MSKCC) RC database between 1995 and 2005 was performed. All complications within 90 days of surgery were recorded and classified using a 5-grade modification of the Clavien system.
Of 1,142 study patients, 280 (25%) were female. Preoperatively, females were more likely to have multiple co-morbidities (39% vs. 27%, P < 0.001), a prior abdominal surgery (64% vs. 42%, P < 0.001), and to be slightly less obese than men. Females had longer operative times (mean 413 vs. 391 minutes; P = 0.005), higher blood loss (mean 1,322 cc vs. 1,151 cc, P = 0.002), and higher transfusion rates (>4 units red blood cells: 13% vs. 8%; P = 0.025). Although females were significantly more likely than males to experience a complication within 90 days of surgery (72% vs. 62%; P = 0.003); we did not find any important differences in the rate, grade, type, or timing of complications between genders. Additionally, females were less likely than males to receive a continent diversion (25% vs. 40%, P < 0.001) or a pelvic lymph node dissection (90% vs. 96%, P < 0.001).
Females in our cohort had significantly higher blood loss, more transfusions, and a higher rate of complications. Females were also less likely to undergo a node dissection or continent diversion, for reasons not totally attributable to patient or disease characteristics, implying patient or surgeon preference played a role.
根治性膀胱切除术（RC）术后围手术期并发症的性别差异研究较少，但女性的术中出血量和/或输血需求较高。报告方法的差异可能会影响研究结果；因此，我们在一家三级癌症中心采用标准化报告方法评估围手术期并发症的性别差异。
对 1995 年至 2005 年期间 Memorial Sloan-Kettering 癌症中心（MSKCC）RC 数据库进行回顾性分析。记录并采用 Clavien 系统 5 级改良法对术后 90 天内的所有并发症进行分类。
在 1142 名研究患者中，280 名（25%）为女性。术前，女性更可能患有多种合并症（39%比 27%，P<0.001）、有腹部手术史（64%比 42%，P<0.001），且体重指数略低于男性。女性的手术时间更长（平均 413 分钟比 391 分钟，P=0.005）、术中出血量更多（平均 1322cc 比 1151cc，P=0.002）、输血率更高（>4 单位红细胞：13%比 8%，P=0.025）。尽管女性术后 90 天内发生并发症的风险显著高于男性（72%比 62%，P=0.003），但我们没有发现性别间并发症的发生率、严重程度、类型或时间上有显著差异。此外，女性接受尿流改道（25%比 40%，P<0.001）和盆腔淋巴结清扫（90%比 96%，P<0.001）的比例显著低于男性。
本队列中的女性术中出血量更大、输血更多、并发症发生率更高。女性也不太可能接受淋巴结清扫或尿流改道，原因不仅是患者或疾病特征，这表明患者或外科医生的偏好也起了作用。
