THE COMPLICATIONS OF RADICAL CYSTECTOMY WITH ORTHOTOPIC URINARY DIVERSION
Objective. Radical cystectomy is a “gold standard” of treatment of patients with muscle-invasive or high risk non-muscle-invasive bladder cancer and is associated with high quantity of postoperative complications. The aim of our study was to analyse the complications of radical cystectomy with orthotopic urinary diversion. Material and methods. Studer radical cystectomy was performed in the Department of Urology in 57 patients in the age of 38-93 years (median - 67). In this group 45 (78.9%) were male and 12 (21.1%) were female. Results. Twenty four complications occurred in 20 of 57 patients (42.1%). Two patients (3.5%) died in the postoperative period. Three of 24 complications were bladder related, while 21 were due to other reasons. We registered 15 (26.3%) grade 1-2 and 9 (15.7) grade 3-5 complications according to Clavien-Dindo classification. Re-operation was required in 5 cases. Indications for surgery were: incompetence of bowel anastomosis (3/5.2%), mechanical bowel obstruction (1/1.7%) and wound-related complications (1/1.7%) cases. Conclusion. Radical cystectomy is a large-scale and complicated reconstructive urologic surgery, which is associated with considerable amount of postoperative complications. Surgery technic mastering, meticulous patient selection and robotic-assisted laparoscopic methods forthcoming are the keys to minimize the quantity of complications and surgery-related mortality. Keywords: radical cystectomy; bladder cancer; orthotopic plastic; complications of Clavien-Dindo.
About the authorsLoran O.B.
Seregin Igor' Vasil'evich
Matveev B.P. (Ed.) Clinical onco-urology. Moscow: ABV-press; 2011: 265-446 (in Russ.).
Witjes J.A., Comperat E., Cowan N.C., De Santis M., Gakis G., Lebret T. et al. EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur. Urol. 65 (4): 778-92. DOI: 10.1016/j.eururo. 2013.11.046
Krasnyy S.A., Sukonko O.G, Polyakov S.L., Rolevich A.I., Minich A.A., Mavrichev A.S. et al. Predictors of early severe complications of radical cystectomy. Onkourologiya (Onco-urology, Russian journal). 2010; 4: 42-6 (in Russ.)
Mager V.O., Zavatskiy S.E., Il'in K.A., Zamyatin A.V., Orlov A.S., Shcheglova V.P. Early postoperative complications after radical cystectomy. Onkourologiya (Onco-urology, Russian journal). 2011; 3: 85-9. (in Russ.).
Mattei A., Birkhaeuser F.D., Baermann C., Warncke S.H., Studer U.E. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J. Urol. 2008; 179 (2): 582-6. DOI: 10.1016/j.juro.2007.09.066
Hautmann R.E., Volkmer B.G., Schumacher M.C., Gschwend J.E., Studer U.E. Long-term results of standard procedures in urology: the ileal neobladder. World J. Urol. 2006; 24 (3): 305-14. DOI: 10.1007/s00345-006-0105-z
Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004; 240 (2): 205-13.
Kogan M.I., Vasilyev O.N. Retrospective analysis of the results of radical cystectomy in non-muscle invasive bladder cancer. Onkourologiya (Onco-urology, Russian journal). 2012; 8 (1): 36-43 (in Russ.).
Meyer J.P., Blick C., Arumainayagam N., Hurley K., Gillatt D., Persad R., Fawcett D. A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients. BJUInt. 2009; 103 (5): 680-3. DOI: 10.1111/j.1464-410X.2008.08204.x
Jensen J.B., Lundbeck F., Jensen K.M. Complications and neobladder function of the Hautmann orthotopic ileal neobladder. BJU Int. 2006; 98 (6): 1289-94. DOI: 10.1111/j.1464-410X.2006.06449.x
Nieuwenhuijzen J.A., de Vries R.R., Bex A., van der Poel H.G., Meinhardt W., Antonini N., Horenblas S. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions. Eur. Urol. 2008; 53 (4): 834-42. DOI: 10.1016/j.eururo.2007.09.008
Nielsen M.E., Mallin K., Weaver M.A., Palis B., Stewart A., Winchester D.P., Milowsky M.I. Association of hospital volume with conditional 90-day mortality after cystectomy: an analysis of the National Cancer Data Base. BJU Int. 2014; 114 (1): 46-55. DOI: 10.1111/bju.12566
Hounsome L.S., Verne J., McGrath J.S., Gillatt D.A. Trends in operative caseload and mortality rates after radical cystectomy for bladder cancer in England for 1998-2010. Eur. Urol. 2015; 67 ( 6): 1056-62. DOI: 10.1016/j.eururo.2014.12.002
Shabsigh A., Korets R., Vora K.C., Brooks C.M., Cronin A.M., Savage C. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur. Urol. 2009; 55 (1): 164-76. DOI: 10.1016/j.eururo.2008.07.031
Svatek R.S., Fisher M.B., Matin S.F., Kamat A.M., Grossman H.B., Nogueras-González G.M. et al. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J. Urol. 2010; 183 (3): 929-34. DOI: 10.1016/j.juro.2009.11.038
Hautmann R.E., De Petriconi R., Gottfried H.W., Kleinschmidt K., Mattes R., Paiss T. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J. Urol. 1999; 161 (2): 422-8.
Kim M.J., Min G.E., Yoo K.H., Chang S.G., Jeon S.H. Risk factors for postoperative ileus after urologic laparoscopic surgery. J. Korean Surg. Soc. 2011; 80 (6): 384-9. DOI: 10.4174/jkss.2011.80.6.384
Hollenbeck B.K., Miller D.C., Taub D., Dunn R.L., Khuri S.F., Henderson W.G. et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J. Urol. 2005; 174 (4 Pt. 1): 1231-7.
Person B., Wexner S.D. The management of postoperative ileus. Curr. Probl. Surg. 2006; 43 (1): 6-65. DOI: 10.1067/j.cpsurg. 2005.10.004
Iyer S., Saunders W Impact of post-operative ileus (POI) on hospital length of stay in colectomy surgery patients [abstract]: American College of Gastroenterology Annual Scientific Meeting. 2007 Oct 12-17. Philadelphia, PA; 2007.
Sun A.J., Djaladat H., Schuckman A., Miranda G., Cai J., Daneshmand S. Venous thromboembolism following radical cystectomy: significant predictors, comparison of different anticoagulants and timing of events. J. Urol. 2015; 193 (2): 565-9. DOI: 10.1016/j.juro.2014.08.085
Vandlac A.A., Cowan N.G., Chen Y., Anderson R.E., Conlin M.J., La Rochelle J.C. et al. Timing, incidence and risk factors for venous thromboembolism in patients undergoing radical cystectomy for malignancy: a case for extended duration pharmacological prophylaxis. J. Urol. 2014; 191 (4): 943-7. DOI: 10.1016/j.juro.2013.10.096
- Refbacks are not listed
Контент доступен под лицензией Creative Commons Attribution 3.0 License.