Интраоперационные осложнения радикальной цистэктомии с различными вариантами деривации мочи

Abstract

To investigate the rates, types and risk factors for intraoperative complications in patients with bladder cancer undergoing radical cystectomy with various types of urinary diversions. The study comprised 257 patients, including 241 (93.8%) men and 16 (6.2%) women who underwent radical cystectomy. The mean age of the patients was 58.5 (37-81) years. The analysis included intraoperative blood loss and blood transfusion, the rates of vascular, rectum and nerve injury, and operative time as a function of type of urinary diversion and cystectomy, the type of surgery, tumor stage (pT and pN), body mass index, and the total number of radical cystectomies performed by the surgical team. Intraoperative mortality was 0.4%. Intraoperative complications were registered in 34 (13.2%) patients. The mean blood loss was 597 (100-2500) ml, mean volume of intra- and perioperative blood transfusion was 950 and 310 ml, respectively. Statistically significant predictors of intraoperative blood loss were body mass index (p=0.001), the surgeons experience (p=0.004) and the presence of lymph node metastases (N+) (p=0.033). A significant factor affecting the rate of rectal injury is a stage pT4 disease (p=0.028). Nerve injury rates did not differ statistically significantly depending on the above factors (p>0.05). Patients with locally advanced bladder cancer and high body mass index should be operated on by highly qualified surgeons performing at least 50 radical cystectomies per year.