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

Abstract

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.

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

“…They also reported a worse crude cancer-specific survival for patients experiencing post-RARC complications than those without. 1 In this study, intracorporeal urinary diversion (ICUD) was significantly associated with increased overall gastrointestinal (GI) complications compared with extracorporeal urinary diversion (ECUD). 1 This finding may disappoint expectations of many urologic surgeons.…”

“…1 In this study, intracorporeal urinary diversion (ICUD) was significantly associated with increased overall gastrointestinal (GI) complications compared with extracorporeal urinary diversion (ECUD). 1 This finding may disappoint expectations of many urologic surgeons. In a recent systematic review and meta-analysis, despite comparable incidences of overall and major post-RARC complications between ICUD and ECUD, ICUD exhibited a significantly reduced risk of major complications in high-volume centers.…”

“…Intriguingly, Kim et al demonstrated dyslipidemia as a risk factor of overall and major GI complications. 1 Post-operative intraperitoneal adhesion formation develops in response to peritoneal injuries via the production of an inflammatory exudate and fibrin bands. Under normal conditions, these bands are resolved by fibrinolysis; however, the fibrinolytic system is suppressed under inflammatory or ischemic conditions and consequently fibrin bands are infiltrated with inflammatory cells and fibroblasts to organize into dense adhesions.…”

“…In this study, intracorporeal urinary diversion (ICUD) was significantly associated with increased overall gastrointestinal (GI) complications compared with extracorporeal urinary diversion (ECUD) 1 . This finding may disappoint expectations of many urologic surgeons.…”

“…demonstrated that diabetes, chronic kidney disease, dyslipidemia, and higher intraoperative fluid volume were independent risk factors of post‐robot‐assisted radical cystectomy (RARC) complications. They also reported a worse crude cancer‐specific survival for patients experiencing post‐RARC complications than those without 1 …”