Obesity is associated with adverse short-term perioperative outcomes in patients treated with open and robot-assisted radical cystectomy for bladder cancer

Deuker, Marina; Stolzenbach, Lara Franziska; Ruvolo, Claudia Collà; Nocera, Luigi; Mansour, Mila; Tian, Zhe; Roos, Frederik C.; Becker, Andreas; Kluth, Luis A.; Tilki, Derya; Shariat, Shahrokh F.; Saad, Fred; Chun, Felix K.‐H.; Karakiewicz, Pierre I.

doi:10.1016/j.urolonc.2020.06.020

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…In that study, similar estimates were detected for mortality, reoperations and readmissions, however, patients subjected to RARC had lower relative risk of any complication (0.44), any wound complications (0.64), blood transfusion (0.70), SSI (0.78) and wound disruption (0.77). In contrast, another multicentre register-based study reported similar complication rates between ORC and RARC [42], whereas confirming a trend of increased complication rates as well as more frequent use of RARC with higher BMI. Thus, uncertainty remains regarding potential additional benefit of RARC in obese patients, but concerns regarding prolonged Trendelenburg position and operating time is likely compensated for by other factors, such as e.g.…”

Section: Robotic-assisted Vs Open Surgical Techniquementioning

confidence: 74%

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Bobjer

2021

Current Opinion in Urology

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Purpose of reviewUrinary diversion (UD) with or without cystectomy is a procedure with high short term complication rates. In this review, we summarize the most relevant findings of the last 2 years.Recent findingsThe use of a prophylactic mesh decreases the risk of parastomal hernia after ileal conduit (IC) surgery without adding mesh-related complications according to a recent randomized multicentre trial. Robot-assisted surgery is increasingly applied for UD and is evolving from extra- to intra-corporeal reconstruction in both continent and incontinent diversions, but there is still a need for appropriately designed studies assessing both short- and long-term complications. Promising techniques to decrease ureterointestinal stricture rates have been reported from small series, such as retrosigmoid placement of the proximal IC to avoid transpositioning of the left ureter, or in robot-assisted surgery the use of indocyanine green with near-infrared light to improve visualisation of distal ureteral viability.SummaryMost recent reports derive from observational data. Appropriate randomized studies are warranted for the evaluation of new techniques to be implemented in a surgical area that still is associated with high complication rates.

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Section: Robotic-assisted Vs Open Surgical Techniquementioning

confidence: 74%

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Bobjer

2021

Current Opinion in Urology

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“…Many factors have been elucidated to be associated with postoperative complications. One study 14 reported obesity independently predicted overall complications, high‐grade complications, longer LOS, and higher total hospital charges (all P < 0.010). Another study 15 found patient age (OR 1.04, 95% CI 1.02–1.06, P = 0.001), higher CCI (OR 1.13, 95% CI 1.03–1.23, P = 0.007), ICUD approach (OR 0.58, 95% CI 0.37–0.97, P = 0.037), and longer operative time (OR 1.002, 95% CI 1.001–1.004, P = 0.013) to be associated with postoperative complications.…”

Section: Discussionmentioning

confidence: 98%

“…Unfortunately, our results found that those factors are underpowered to reveal any association with complications. Evidence that the risk of post-RARC complications is significantly higher in patients with DM, CKD, and dyslipidemia has been reviewed separately and individually in several literatures, [14][15][16][17][18][19][20] but our strength is considered to be the first to try to reveal an association in one study at once. Knorr et al 16 reported that chronic obstructive pulmonary disease (P = 0.030), CCI (P = 0.020), and Indiana pouch diversion (P = 0.002) were significant predictors of early complication.…”

Section: Discussionmentioning

confidence: 99%

Predicting factor analysis of postoperative complications after robot‐assisted radical cystectomy: Multicenter KORARC database study

et al. 2022

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Objectives To evaluate postoperative complications following robot‐assisted radical cystectomy in patients diagnosed with bladder cancer and reveal if there are predictors for postoperative complications. Methods Prospectively collected medical records of 730 robot‐assisted radical cystectomy patients between 2007/04 and 2019/05 in 13 tertiary referral centers were reviewed. Perioperative outcomes were compared between two groups by postoperative complications (complication vs non‐complication). We assessed recurrence‐free survival, cancer‐specific survival, and overall survival between groups. Regression analyses were implemented to identify factors associated with postoperative complications. Results Any total and high‐grade complication (Clavien–Dindo grade ≥3) rates were 57.8% and 21.1%, respectively. Patients in complication group had significantly higher proportion of diabetes mellitus (P = 0.048), chronic kidney disease (P = 0.011), dyslipidemia (P < 0.001), longer operation time (P = 0.001), more estimated blood loss (P = 0.001), and larger intraoperative fluid volume (P < 0.001). There was a significant difference in cancer‐specific survival (log‐rank P = 0.038, median cancer‐specific survival: both groups not reached). Dyslipidemia (odds ratio 2.59, P = 0.002) and intraoperative fluid volume (odds ratio 1.0002, P = 0.040) were significantly associated with high‐grade postoperative complications. Diabetes mellitus (odds ratio 1.97, P = 0.028), chronic kidney disease (odds ratio 1.89, P = 0.046), dyslipidemia (odds ratio 5.94, P = 0.007), and intraoperative fluid volume (odds ratio 1.0002, P = 0.009) were significantly associated with any postoperative complications. Conclusions Patients with diabetes mellitus, chronic kidney disease, dyslipidemia, or a relatively large intraoperatively infused fluid volume are more likely to develop postoperative complications. Patients with postoperative complications might have a possibility of lower cancer‐specific survival rate.

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“…According to their work, the most common complications were genitourinary (24%), gastrointestinal (19%), and infectious complications (15%), whereas in our analysis infectious complications were the most common, followed by gastrointestinal complications. Deuker et al (19) just recently published an analysis of 11,594 patients undergoing robot-assisted RC vs. ORC testing the effects of obesity and surgical approach on perioperative outcomes and total hospital charges. Among others, they found that obesity independently predicted overall complications and major complications.…”

Section: Discussionmentioning

confidence: 99%

Perioperative and Pathological Outcome of Nerve-Sparing Radical Cystectomy With Ileal Neobladder

et al. 2021

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Purpose: So far, it has not been described whether the perioperative course and the pathologic outcome of patients who undergo radical cystectomy (RC) with orthotopic bladder substitution differs if nerve sparing (NS) is performed or not.Material and Methods: In all, there were 472 patients who underwent RC between 2012 and 2019 at our department. We performed a retrospective analysis of 116 patients who underwent RC with ileal neobladder. We analyzed perioperative complications according to the Clavien–Dindo classification system, as well as the pathological outcome.Results: Of 116 patients, 68 (58.6%) underwent RC, and 48 (41.4%) underwent NS RC. Clavien–Dindo complications ≥3b occurred in 15 (12.9%) of all patients. Only infectious complications differed among the groups [NS RC: 25 patients (52.1%) vs. RC: 20 patients (29.4%); p = 0.02]. There was no significant difference concerning tumor stage. Concomitant Cis was present in 24 patients (35.3%) of the RC group and in 27 patients (56.3%) of the NS RC group (p = 0.036). Nodal status and positive surgical margin status of the bladder tumor did not differ among the groups. In all, 42 of all male patients (45.7%) had an incidental prostatic carcinoma. Positive surgical margins concerning the prostate carcinoma occurred in six patients, with all cases in the RC group (p = 0.029).Conclusions: Our data suggest that performing NS during RC in carefully selected patients is a safe procedure and does not impair perioperative outcome. Pathological outcome of NS RC is comparable as well.

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Obesity is associated with adverse short-term perioperative outcomes in patients treated with open and robot-assisted radical cystectomy for bladder cancer

Cited by 10 publications

References 21 publications

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Predicting factor analysis of postoperative complications after robot‐assisted radical cystectomy: Multicenter KORARC database study

Perioperative and Pathological Outcome of Nerve-Sparing Radical Cystectomy With Ileal Neobladder

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