Early complications of radical cystectomy with various types of urine diversion: prognostic factors analysis

Abstract

Objective: to analyze factors predicting complications in a series of radical cystectomies (RCs) performed for bladder cancer over a 10-year period at the National Center of Oncology (Baku).Materials and methods. From July 2008 to December 2017 we retrospectively selected 257 consecutive cases of RC with pelvic lymphadenectomy and various options of urine diversion for bladder malignant neoplasms. Information on preoperative prognostic factors, including demographic parameters, as well as general patient health parameters, tumor characteristics and factors concerning the operation was obtained from medical records. We analyzed perioperative factors using monovariant logistic regression, where the endpoints were development of any complication (I–V degrees according to Clavien–Dindo classification), as well as severe complication (III–V grades) within 30-days after RC were considered the endpoints. After the missing data on preoperative bacteriological urinalysis were multiply imputed, a multivariate logistic regression has been performed with odds ratio (OR) calculation.Results. During the 30-day period, complications were registered in 111 (43.2 %) patients, severe complications – in 48 (18.7 %). Multivariate analysis revealed the following independent predictors of any postoperative complications after RC: local cT4 tumor extension (OR 4.52; p = 0.002), age (OR 1.87; p = 0.017), positive bacteriological urine analysis (OR 2.16; p = 0.032) and number of performed RCs (OR 0.89; p = 0.038). Severe postoperative complications were associated with positive urine culture (OR 4.05; p = 0.002) and age (OR 2.44; p = 0.013).Conclusion. Our study revealed the following independent factors, which were significantly associated with the risk of any complication or severe complication after RC: local cT4 tumor extension, age, positive urine bacteriological analysis before the intervention and a small number of surgeries or positive urine culture and age, respectively.