Department of Urology, Sapporo Medical University School of Medicine, Minami-1 Nishi-16, Chuo-ku, Sapporo, 060-8543, Japan.
Sapporo Medical University Urologic Oncology Consortium (SUOC), Sapporo, Japan.
Int J Clin Oncol. 2018 Aug;23(4):734-741. doi: 10.1007/s10147-018-1245-z. Epub 2018 Feb 13.
We prospectively evaluated the 90-day postoperative mortality and morbidity of open radical cystectomy by using a standardized reporting methodology. Additionally, we assessed the preoperative characteristics to determine risk factors for major complications.
This multicenter prospective study included 185 consecutive patients undergoing open radical cystectomy from October 2010 through March 2014. Postoperative complications within 90 days were recorded and graded according to the modified Clavien-Dindo classification.
Totally, 328 postoperative complications were observed in 149 patients (80.5%). Of these events, 73 (22.2%) were high grade (≥ Grade III), and developed in 46 patients (24.9%). Three patients (1.6%) died postoperatively. Urinary tract infection, wound complications, and paralytic ileus were common complications that occurred in 55 (29.7%), 42 (22.7%) and 41 (22.2%) patients, respectively. Ureteroenteric stricture was diagnosed in 13 of the 151 patients (8.6%) undergoing intestinal urinary diversion. Emergency room visits were required for 13 patients (7.0%) and readmission after discharge was needed for 36 (19.5%). A body mass index ≥ 25 kg/m, smoking history and Charlson Comorbidity Index ≥ 2 were independent risk factors for high-grade complications, and their odds ratios (95% confidence intervals) were 2.357 (1.123-4.948), 2.843 (1.225-6.596) and 3.025 (1.390-6.596), respectively.
Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.
我们采用标准化报告方法前瞻性评估了开放性根治性膀胱切除术的 90 天术后死亡率和发病率。此外，我们评估了术前特征以确定主要并发症的危险因素。
这项多中心前瞻性研究纳入了 2010 年 10 月至 2014 年 3 月期间接受开放性根治性膀胱切除术的 185 例连续患者。记录了 90 天内的术后并发症，并根据改良 Clavien-Dindo 分类进行分级。
149 例患者中共有 328 例术后并发症（80.5%）。这些事件中，73 例（22.2%）为高等级（≥III 级），46 例（24.9%）发生。3 例患者（1.6%）术后死亡。尿路感染、伤口并发症和麻痹性肠梗阻是常见并发症，分别发生于 55 例（29.7%）、42 例（22.7%）和 41 例（22.2%）患者。151 例行肠道尿流改道术的患者中有 13 例（8.6%）诊断为输尿管肠吻合口狭窄。13 例（7.0%）需要急诊就诊，36 例（19.5%）需要出院后再入院。体质指数≥25kg/m2、吸烟史和 Charlson 合并症指数≥2 是高等级并发症的独立危险因素，其优势比（95%置信区间）分别为 2.357（1.123-4.948）、2.843（1.225-6.596）和 3.025（1.390-6.596）。
开放性根治性膀胱切除术术后并发症发生率较高，但大多数为低等级。我们的结果表明，肥胖、吸烟史和合并症增加是主要并发症的危险因素。
