Complication reporting with the Bern Comprehensive Complication Index CCI after open radical prostatectomy: A longitudinal long-term single-center study

Löffel, Lukas M.; Gross, Tobias; Schneider, Marc P.; Burkhard, Fiona C.; Thalmann, George N.; Bosshard, Piet; Wuethrich, Patrick Y.; Furrer, Marc A.

doi:10.1016/j.urolonc.2019.09.021

Cited by 10 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Comprehensive Complication Index (CCI) values were then derived from the Clavien-Dindo grades. The Bern CCI was calculated using our recently developed modified CCI formula [21,22].…”

Section: Complicationsmentioning

confidence: 99%

Oncological outcomes after attempted nerve‐sparing radical prostatectomy (NSRP) in patients with high‐risk prostate cancer are comparable to standard non‐NSRP: a longitudinal long‐term propensity‐matched single‐centre study

Furrer,

Sathianathen,

Gahl

et al. 2023

BJU International

Self Cite

View full text Add to dashboard Cite

ObjectiveTo assess the long‐term safety of nerve‐sparing radical prostatectomy (NSRP) in men with high‐risk prostate cancer (HR‐PCa). HR‐PCa is associated with higher incidence of extra prostatic disease. This has led to the concept that NS should be avoided to prevent positive surgical margins (PSM) as they may increase risk of disease recurrence. Whether NSRP should be attempted in these patients remains a matter of debate. We aim to compare survival outcomes, disease recurrence the need for additional therapy and peri‐operative outcomes of patients undergoing NSRP to those without any NS.Materials and methodsWe included consecutive patients at a single, academic centre undergoing open RP for HR‐PCa, defined as preoperative PSA>20 ng/ml and/or postoperative ISUP‐grade group 4 or 5 (i.e. Gleason score ≥ 8) and/or ≥ pT3 and/or pN1 assessing the prostatectomy and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of HR‐PCa patients undergoing NSRP to those having non‐NSRP. We analyzed oncological outcome as time‐to‐event and calculated hazard ratios (HR).ResultsA total of 726 patients were included in this analysis of which 84% (n=609) underwent NSRP. There was no evidence for the PSM being different between the NSRP and non‐NSRP groups (47% vs 49%, p=0.64). Likewise, there was no evidence for the need for post‐operative radiotherapy being different in men who underwent NSRP from those who did not have nerves spared (HR 0.78, 95%CI 0.53–1.15).NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73–1.34, p=0.09) and there was no evidence for the survival being different in men who underwent NSRP to those who had non‐NSRP (HR 0.65, 95%CI 0.39–1.08). There was also no evidence for the cancer‐specific survival (0.56, 95%CI 0.29–1.11) nor progression‐free survival (H) 0.99, 95%CK 0.73–1.34) being different between both groups.ConclusionIn patients with HR‐PCa NSRP can be attempted without compromising long‐term oncological outcomes provided a comprehensive assessment of objective (e.g. T‐stage) and subjective (e.g. intraoperative appraisal of tissue planes) criteria is conducted.

show abstract

“…The Comprehensive Complication Index (CCI) values were then derived from the Clavien-Dindo grades. The Bern CCI was calculated using our recently developed modified CCI formula [21,22].…”

Section: Complicationsmentioning

confidence: 99%

Oncological outcomes after attempted nerve‐sparing radical prostatectomy (NSRP) in patients with high‐risk prostate cancer are comparable to standard non‐NSRP: a longitudinal long‐term propensity‐matched single‐centre study

Furrer,

Sathianathen,

Gahl

et al. 2023

BJU International

Self Cite

View full text Add to dashboard Cite

show abstract

“…Laparoscopic radical prostatectomy is the recommended procedure for localized PCa patients, but injuries caused by lymph node dissection, such as lymphocele, thromboembolic events, or urine leaks, can affect the patient’s quality of life in various ways depending on the severity or require surgical management 24 – 26 . The oncological benefit of pelvic lymph node dissection remains controversial after evaluation in multiple clinical studies 27 , 28 . We expect to screen patients at high risk by improving the diagnostic rate of lymph node metastases before prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic capability of 18F-PSMA PET-MRI and pelvic MRI plus bone scan in treatment-naive prostate cancer: A single-center paired validating confirmatory study

Qiao,

Wang,

Wang

et al. 2023

International Journal of Surgery

View full text Add to dashboard Cite

Background: Radical prostatectomy with pelvic lymph node dissection for the treatment of high-risk localized prostate cancer (PCa) results in long-term benefits in selected patients. But insufficient sensitivity of conventional examinations which are pelvic MRI and bone scan, limits the diagnosis of bone and lymph node metastasis of PCa. This affects the surgical management strategy of a large number of patients. The purpose of this study was to investigate whether 18F-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)-magnetic resonance imaging (MRI) could improve the clinical detection of PCa metastases compared with the conventional pelvic MRI plus bone scan. Materials and Methods: From April 2020 to April 2023, we prospectively enrolled 472 patients with histologically proven PCa in our center, and 120 patients underwent 18F-PSMA PET-MRI, multiparametric MRI (mpMRI), and bone scan before laparoscopic radical prostatectomy plus lymph node dissection. The accuracy of imaging results in detecting lymph node and bone metastatic lesions was compared between PSMA PET-MRI and MRI plus bone scan. Results: In diagnosing lymph node metastasis, PSMA PET-MRI had an area under the curve (AUC) of 0.844 (95% confidence intervals [CI]: 0.738–0.949, P < 0.001), sensitivity and specificity of 75% and 96%, which performed apparently better than MRI (AUC=0.615 [95% CI: 0.480–0.750, P=0.073]). PSMA PET-MRI showed excellent expression in the diagnosis of bone metastases, with an AUC of 0.910 (95% CI: 0.840–0.981, P <0.001) compared to 0.700 (95% CI: 0.577–0.823, P =0.001) in bone scanning. PSMA PET-MRI also had higher sensitivity than bone scanning (90% vs. 43%), while lower specificity (92% vs. 97%). Conclusion: PSMA PET-MRI is superior to conventional imaging at diagnosing metastases in lymph nodes and bones in PCa and can provide a more accurate stagement.

show abstract

“…When the CDC is used in many surgical fields, it is frequently discovered that it can only show the most serious complication, and the ability to report additional complications or the total number of complications is insufficient, resulting in a poor assessment of the cumulative incidence of complications. 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Compared to the CDC, the CCI as a continuous variable scoring system not only includes all postoperative complications, but also the cumulative complications in patients with a greater load rate. It can also be combined with the cumulative sum model, which can be used in monitoring surgical morbidity and comparing different surgical operation performances.…”

Section: Discussionmentioning

confidence: 99%

The CUSUM curve combined with comprehensive complication index for assessing short‐term complications of radical cystectomy

Zhou

Gao

Liao

et al. 2022

Clinical Laboratory Analysis

View full text Add to dashboard Cite

Objective To evaluate the comprehensive complication index(CCI) and Clavien‐Dindo classification(CDC) for short‐term postoperative complications in radical cystectomy and assess cumulative surgical morbidity to compare sufficient surgical skill. Methods From September 30, 2010, to October 1, 2020, clinical data of patients with urothelial carcinoma who underwent radical cystectomy with urinary diversion were gathered, patients who had only a urinary diversion, bladder sparing surgery, additional abdominal surgeries at the same time were all excluded. The CDC and CCI were utilized to evaluate 30‐d complications after radical cystectomy and the relevance of hospital stay was compared between CCI and CDC. The cumulative sum control models (CUSUM) were used to evaluate the overall surgical morbidity of radical cystectomy in our facility and for comparisons between surgeons. Results This study enrolled a total of 635 individuals, 548 (86.3%) of whom had 1124 problems. The incidence of severe complications (CDC≥ Grade III) was 10.2%. The average CCI was 20.2 ± 14.7. Gender, urinary diversion subtype, procedure method, and surgeon were significantly correlated with the increase of CCI ( p < 0.05). The CCI demonstrated a better relationship with hospital stay ( R 2 = 0.429) than the CDC (R 2 = 0.361). The CUSUM‐CCI model demonstrated a difference and growth distribution in dynamic time between individual surgeons. Conclusions CCI can better reflect the incidence of complications for radical cystectomy than CDC, and CCI is more strongly correlated with postoperative hospital stay. The CUSUM‐CCI model can reflect the quality of surgical skill for each surgeon instantaneously.

show abstract

Complication reporting with the Bern Comprehensive Complication Index CCI after open radical prostatectomy: A longitudinal long-term single-center study

Cited by 10 publications

References 26 publications

Oncological outcomes after attempted nerve‐sparing radical prostatectomy (NSRP) in patients with high‐risk prostate cancer are comparable to standard non‐NSRP: a longitudinal long‐term propensity‐matched single‐centre study

Oncological outcomes after attempted nerve‐sparing radical prostatectomy (NSRP) in patients with high‐risk prostate cancer are comparable to standard non‐NSRP: a longitudinal long‐term propensity‐matched single‐centre study

Diagnostic capability of 18F-PSMA PET-MRI and pelvic MRI plus bone scan in treatment-naive prostate cancer: A single-center paired validating confirmatory study

The CUSUM curve combined with comprehensive complication index for assessing short‐term complications of radical cystectomy

Contact Info

Product

Resources

About