Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ann Surg Oncol. 2018 Feb;25(2):573-581. doi: 10.1245/s10434-017-6251-2. Epub 2017 Nov 14.
Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and the risk of major postoperative complications has not been systematically investigated.
The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE.
Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher's exact test with Chi square and two-tailed t test were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications.
In this population, 53 (65.4%) patients had Clavien grade 0-2 complications ('no major complications') and 28 (34.6%) patients had Clavien grade 3-5 complications ('major complications'). Compared with the major complications group, patients in the no major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher preoperative serum albumin, and shorter duration of hospitalization (p < 0.05 for all). Major complications were more common in low-volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (odds ratio [OR] 6.25, 95% confidence interval [CI] 1.42-27.47; p = 0.015) and surgery by a provider who performed three or fewer cases during the study interval (OR 13.4, 95% CI 2.20-80.89; p = 0.005) were independent predictors for major complications.
High CCI should alert providers to increased probability of major complications, and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.
完全性尿路切除（CUTE）是一种复杂的手术，围手术期并发症风险较大。临床特征与主要术后并发症风险之间的关系尚未系统研究。
本研究旨在分析 CUTE 术后主要围手术期并发症的发生率和风险。
对 2004 年 1 月至 2015 年 12 月期间接受一期 CUTE 治疗的 81 例尿路上皮癌（UC）患者的病历进行回顾性分析。采用 Fisher 精确检验（卡方检验）和双侧 t 检验分别用于分类变量和连续变量。采用单变量和多变量逻辑回归模型评估主要并发症的发生概率。
在该人群中，53 例（65.4%）患者发生 Clavien 0-2 级并发症（“无重大并发症”），28 例（34.6%）患者发生 Clavien 3-5 级并发症（“重大并发症”）。与重大并发症组相比，无重大并发症组患者年龄较小，Charlson 合并症指数（CCI）较低，术前血清白蛋白较高，住院时间较短（所有 p 值均<0.05）。低容量外科医生更常发生重大并发症（p=0.002）。多变量逻辑回归分析显示，CCI≥5（优势比 [OR] 6.25，95%置信区间 [CI] 1.42-27.47；p=0.015）和在研究期间仅进行 3 例或更少病例手术的外科医生（OR 13.4，95%CI 2.20-80.89；p=0.005）是主要并发症的独立预测因素。
高 CCI 应引起医务人员警惕，增加发生重大并发症的概率，并在 CUTE 后进行警惕性管理。外科医生的手术量与主要术后并发症呈负相关。
