Kurokawa Masayuki, Sugihara Toru, Watanabe Risako, Hoshina Hayato, Takaoka Eiichiro, Ando Satoshi, Kamei Jun, Fujimura Tetsuya
Department of Urology, Jichi Medical University, Shimotsuke, JPN.
Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, JPN.
Cureus. 2025 May 20;17(5):e84470. doi: 10.7759/cureus.84470. eCollection 2025 May.
Objective The objective of this study is to assess how the preoperative prognostic nutritional index (PNI) affects the occurrence of postoperative complications in patients undergoing robot-assisted radical cystectomy (RARC). Methods We retrospectively analyzed data from 103 patients who underwent RARC at Jichi Medical University Hospital between June 2018 and December 2023. The PNI was calculated using the following formula: 10 × serum albumin + 0.005 × total lymphocyte count. Patients were divided into high- and low-PNI groups based on a threshold value of 45. Postoperative complications occurring within 30 days were compared between the two groups, and risk factors were identified using multivariate logistic regression analysis. Results Postoperative complications occurred in 50 patients (48.5%), with eight patients (8%) experiencing severe complications (Clavien-Dindo Grade ≥3). The most common complication was postoperative ileus, affecting 26% of patients (n = 28). The low-PNI group had significantly higher rates of overall complications (70% vs. 47%, p< 0.05) and postoperative ileus (48% vs. 18%, p < 0.05) compared to the high-PNI group. Multivariate analysis identified low PNI (ORs: 3.82 for overall complications and 3.90 for ileus) and intestinal urinary diversion (ORs: 3.33 and 5.34, respectively) as independent risk factors. Conclusions The preoperative PNI is a significant predictor of both overall complications and postoperative ileus following RARC. These findings underscore the importance of preoperative immunonutritional assessment for risk stratification and suggest that nutritional screening and immunonutritional interventions may enhance postoperative outcomes in high-risk patients.
目的 本研究旨在评估术前预后营养指数（PNI）如何影响接受机器人辅助根治性膀胱切除术（RARC）患者术后并发症的发生情况。方法 我们回顾性分析了2018年6月至2023年12月期间在秩父医科大学医院接受RARC的103例患者的数据。PNI采用以下公式计算：10×血清白蛋白 + 0.005×总淋巴细胞计数。根据阈值45将患者分为高PNI组和低PNI组。比较两组30天内发生的术后并发症，并使用多因素逻辑回归分析确定危险因素。结果 50例患者（48.5%）发生术后并发症，8例患者（8%）出现严重并发症（Clavien-Dindo分级≥3级）。最常见的并发症是术后肠梗阻，影响26%的患者（n = 28）。与高PNI组相比，低PNI组的总体并发症发生率（70%对47%，p<0.05）和术后肠梗阻发生率（48%对18%，p < 0.05）显著更高。多因素分析确定低PNI（总体并发症的OR值：3.82，肠梗阻的OR值：3.90）和肠道尿流改道（OR值分别为3.33和5.34）为独立危险因素。结论 术前PNI是RARC术后总体并发症和术后肠梗阻的重要预测指标。这些发现强调了术前免疫营养评估对风险分层的重要性，并表明营养筛查和免疫营养干预可能改善高危患者的术后结局。
