Early and Late Complications of Robot-Assisted Radical Cystectomy: A Standardized Analysis by Urinary Diversion Type

Lamb

et al. 2017

European Urology Focus

In-depth critical analysis of complications following robot-assisted radical cystectomy with intracorporeal urinary diversion. European Urology Focus, (doi:10.1016Focus, (doi:10. /j.euf.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/145598/ RESULTS AND LIMITATIONSThe 90-day all complication rate following ileal conduit and continent diversion was 68% and 82.4% while major complications were 21.0% and 20.6% respectively. 90-day mortality was 3% and 2.9% for ileal conduit and continent diversion patients respectively. On multivariate analysis, blood transfusion requirement was independently associated with major (p=0.002) and all 30-day (p=0.002) and 90-day major complications (p=0.012) while male patients were associated with 90-day major complications (p=0.015). Critical analysis identified surgical complications was responsible for 39.4% of all 90-day major complications. PATIENT SUMMARYIn this report, we looked at the surgical outcomes in bladder cancer patients treated with minimal invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from different center even in a randomised trial setting.

Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 82%

“…Similar to other studies, the majority of urinary leaks were managed conservatively with only 25% (2/8) requiring temporary diversion via nephrostomy insertion [21].…”

Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 82%

See 3 more Smart Citations

In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion

Lamb

et al. 2017

European Urology Focus

Clinical Laboratory Analysis

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

Zhou

Gao

Liao

et al. 2022

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.

Neurourology and Urodynamics

Outcomes of right colon continent urinary pouch using standardized reporting methods

Myers

Martin

Cheng

et al. 2019

Aims Studies of right colon pouch urinary diversion estimate risk of perioperative complications, 1%‐50%, and reoperation, 1%‐69%. This wide range is due to variable outcome measurements and reporting methods; it is also unclear which factors increase the risk of complications and reoperation. We sought to characterize the impact of patient‐specific factors on risk of complications, readmission, and reoperation after right colon pouch urinary diversion. Methods Patients undergoing right colon pouch urinary diversion from January 2010 to April 2017 were analyzed. Outcomes included: high‐grade complications within 90 days (Clavien‐Dindo grade ≥3), readmission within 90 days, and reoperation at any time during follow‐up. Patient‐specific factors were analyzed to establish any associations with these outcomes. Results During the study period, 53 patients underwent the procedure and the average follow‐up was 30 (standard deviation [SD] 21.5) months; 90‐day high‐grade complications were 22% and readmission was 45%. The cumulative rate of any reoperation was 53% and major reoperation was 32%. Diabetes was associated with an increased risk of both postoperative complications and reoperation. Larger body mass index and prior abdominal surgery were associated with increased risk of readmission. Conclusions Overall the rate of postoperative complications, readmissions, and reoperation was high, but in agreement with other contemporary series. This study helps to further characterize surgical outcomes after right colon pouch urinary diversion, however, similar to other studies in the literature, the rarity of the procedure limits the power to establish a link between preoperative patient factors and outcomes.