Complications and reoperations after laparoscopic radical cystectomy in a Japanese multicenter cohort

Abstract

Objectives To describe the complications and their surgical management after laparoscopic radical cystectomy in a Japanese multicenter cohort. Methods The participants were drawn from a retrospective multicenter study at 10 institutions. We identified 436 patients who underwent laparoscopic radical cystectomy with no robot assistance. Early and late complications were graded according to their Clavien–Dindo classification. The records of all patients who underwent surgical interventions for laparoscopic radical cystectomy‐specific complications were also reviewed. Kaplan–Meier curves were used to describe the time to surgical intervention. Results The 90‐day rates for overall complications, high‐grade complications (Clavien–Dindo classification III–V) and mortality were 53%, 17% and 1.4%, respectively. Gastrointestinal (25%), infectious (22%) and abdominal wall‐related (9%) complications were the most common. The late complication rate was 18%, and a total of 81 patients (19%) underwent surgical intervention during the median follow‐up period of 22 months. The reoperation rate was 25% at 5 years. Gastrointestinal complications in the early postoperative period and abdominal wall‐related complications in the late postoperative period were the main reasons for reoperation. Seven (7%) out of 100 female patients underwent emergent surgical reoperation for transvaginal bowel evisceration as a result of vaginal dehiscence. Conclusions Early and late postoperative complications and surgical reoperations are notable after laparoscopic radical cystectomy. Abdominal wall‐related complications including vaginal dehiscence are common, and they represent the main indication for reoperation during long‐term follow up.

Editorial Comment from Dr Tanaka and Dr Fujii to Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

“…In the present study, Kanno et al . investigated oncologic outcomes and recurrence patterns after LRC using a substantial number of bladder cancer patients ( n = 411) from a multicentric cohort . After a median follow‐up period of 23 months, 2‐year recurrence‐free, cancer‐specific and overall survival rates were 71.0%, 84.7% and 80.1%, respectively, which were comparable to those of open radical cystectomy previously reported.…”

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

“…This study was approved by the institutional review board of Kyoto University Hospital. A common database template was created, and data were collected retrospectively, as previously described 10 . The methods used in laparoscopic cystectomy, as well as the presence or absence and extent of lymph node dissection, were determined based on the policies of each institution.…”

“…Complications were reported according to the modified Clavien–Dindo classification system 10 . Ureteroenteric stricture was diagnosed when there was evidence of obstruction on imaging, such as symptomatic hydronephrosis, worsening renal function and/or infection, and worsening hydronephrosis that required surgical intervention.…”

Editorial Comment from Dr Abe to Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

“…In this study, Kanno et al. observed that, in a total of 411 patients treated by laparoscopic radical cystectomy, 28 (7%) developed local recurrence in the cystectomy bed, and 17 (4%) developed abdominal recurrence including peritoneal carcinomatosis or port site recurrence . When those recurrence cases were combined into a single group, because tumor dissemination during surgical manipulation might cause this type of recurrence, prolonged surgical time was a significant risk factor, in addition to an advanced pathological stage, positive surgical margin and variant histology based on uni‐ and multivariate models.…”