Abstract
ABSTRACTObjective:To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types.Materials and Methods:We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratified by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD).Results:When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p<0.001) and without RC (34.0% vs 22.0%, p=0.032).Conclusions:RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.
Highlights
Urothelial Carcinoma of the bladder is the sixth most common malignancy in the U.S, with approximately 20% of new diagnoses being muscle invasive
Owing to lower numbers of patients receiving continent UD (CUD), Propensity score matching (PSM) was sub-optimal with notable differences in the matched cohort (Table-2)
This current analysis of a prospectively maintained and well-annotated national dataset found that radical cystectomy and urinary diversion is associated with an increased risk of post-operative complications, bleeding needing transfusion and venous thromboembolism compared to urinary diversion alone
Summary
Urothelial Carcinoma of the bladder is the sixth most common malignancy in the U.S, with approximately 20% of new diagnoses being muscle invasive. Radical cystectomy (RC) with urinary diversion (UD), usually after neoadjuvant chemotherapy (NAC), is regarded as the gold standard in the treatment of muscle invasive bladder cancer (MIBC). This procedure is highly morbid, with complications occurring in up to two-thirds of patients within 90 days [1]. While most of these are minor, up to 20% of patients will experience a major complication, with mortality approaching 10% [2, 3].
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