Nayak Brusabhanu, Garg Harshit, Goel Ritesh, Singh Prabhjot, Nayyar Rishi, Kumar Rajeev, Seth Amlesh
Department of Urology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
Indian J Surg Oncol. 2021 Mar;12(1):86-93. doi: 10.1007/s13193-020-01226-z. Epub 2021 Jan 8.
To evaluate the perioperative outcomes of patients undergoing open radical cystectomy for carcinoma bladder in a tertiary care center. A retrospective analysis of a prospectively maintained database of all patients undergoing open radical cystectomy with a urinary diversion from July 2014 to August 2019 was done. A total of 195 patients were included. A total of 172 patients (88.2%) underwent radical cystectomy with ileal or sigmoid conduit, 6 patients underwent orthotopic neobladder, and 17 patients underwent cutaneous ureterostomy. The mean American Society of Anaesthesiology (ASA) score was 1.4. On preoperative histopathology, 125 patients had the muscle-invasive disease. The mean operative time (± SD) was 303.6 ± 53.4 min and the operative time was significantly longer for neobladder ( = 0.033). The mean blood loss (± SD) was 977.5 ± 346.5 ml. Among the complications, a total of 350 events occurred in 96 patients (49.3%). Thirty-nine patients (20%) suffered grade I complications, 12 patients (6.2%) suffered grade II complications, 26 patients (13.3%) suffered grade III complications, and 9 patients (4.6%) suffered grade IV complications. Grade III, IV, and V complications were considered major complications and 46 patients (23.5%) had major complications. Among the grade III complications, the majority included fascial dehiscence (burst abdomen), i.e., 13.3%, and uretero-ileal leak, i.e., 2.6%. The overall 30-day mortality rate was 5.2% (10/195). On multivariate analysis, the presence of diabetes mellitus ( = 0.047), operative time ( = 0.003), and low preoperative albumin ( = 0.009) were significant predictors for major preoperative complications. Diabetes mellitus, serum albumin, and operative time are significant predictors of postoperative complications. The ASA score, low preoperative hemoglobin, and blood loss are significant predictors of perioperative mortality. Though radical cystectomy has been associated with significant perioperative morbidity and mortality, the advancements in surgical techniques and intensive care tools have led to a significant decrease in morbidity and mortality in the contemporary era.
评估在一家三级医疗中心接受开放性根治性膀胱切除术治疗膀胱癌患者的围手术期结局。对2014年7月至2019年8月期间所有接受开放性根治性膀胱切除术并进行尿流改道的患者的前瞻性维护数据库进行回顾性分析。共纳入195例患者。172例患者（88.2%）接受了回肠或乙状结肠导管根治性膀胱切除术，6例患者接受了原位新膀胱术，17例患者接受了皮肤输尿管造口术。美国麻醉医师协会（ASA）平均评分为1.4。术前组织病理学检查显示，125例患者患有肌层浸润性疾病。平均手术时间（±标准差）为303.6±53.4分钟，新膀胱术的手术时间明显更长（P = 0.033）。平均失血量（±标准差）为977.5±346.5毫升。在并发症方面，96例患者（49.3%）共发生350起事件。39例患者（20%）发生I级并发症，12例患者（6.2%）发生II级并发症，26例患者（13.3%）发生III级并发症，9例患者（4.6%）发生IV级并发症。III、IV和V级并发症被视为主要并发症，46例患者（23.5%）发生主要并发症。在III级并发症中，大多数包括筋膜裂开（腹部裂开），即13.3%，以及输尿管回肠漏，即2.6%。总体30天死亡率为5.2%（10/195）。多因素分析显示，糖尿病（P = 0.047）、手术时间（P = 0.003）和术前白蛋白水平低（P = 0.009）是主要术前并发症的重要预测因素。糖尿病、血清白蛋白和手术时间是术后并发症的重要预测因素。ASA评分、术前血红蛋白水平低和失血量是围手术期死亡率的重要预测因素。尽管根治性膀胱切除术与显著的围手术期发病率和死亡率相关，但手术技术和重症监护工具的进步已导致当代发病率和死亡率显著降低。
