The comprehensive complication index is associated with a significant increase in complication severity between 30 and 90 days after radical cystectomy for bladder cancer

Haas, Maximilian; Huber, Toni; Pickl, Christoph; Gužvić, Miodrag; Gierth, Michael; Breyer, Johannes; Burger, Maximilian; Mayr, Roman

doi:10.1016/j.ejso.2020.09.040

Cited by 16 publications

(11 citation statements)

References 20 publications

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“…GIS (27.5%) complications were the most frequent. Most severe postoperative complications requiring intervention ( CDC ≥ grade IIIb) were found in 18.4%, compatible with the literature [ 1 – 3 , 21 , 22 ].…”

Section: Discussionsupporting

confidence: 90%

“…Interestingly, Vetterlein et al reported urinary tract infection in 62% of the patients (although they did not specify whether the infection was detected by urine culture or only by urinalysis), hematuria in 67% (not specified whether microscopic or macroscopic; probably most of them is not a deviation from an ideal course), and new-onset hydronephrosis in 41% (not specified) [ 2 ]. On the other hand, Haas et al reported 85.7% complications for RC [ 1 ]. However, the largest part of this was related to intraoperative blood transfusion (21.2%), and it was incorrectly graded with CDC.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, RC has higher perioperative complication rates. The reported perioperative complication rates vary from 19% up to 99% within the first 90 postoperative days [ 1 – 6 ]. This big discrepancy may be explained by lack of standardized definitions of perioperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Reporting perioperative complications of radical cystectomy: the influence of using standard methodology based on ICARUS and EAU quality criteria

et al. 2023

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Purpose We aimed to evaluate perioperative complications of radical cystectomy (RC) by using standardized methodology. Additionally, we identified independent risk factors associated with perioperative complications. Materials and methods We retrospectively analyzed 30-day and 90-day perioperative complications of 211 consecutive RC patients. The intraoperative and postoperative complications were defined according to Clavien-Dindo classification (CDC) and reported based on the ICARUS criteria, Martin, and EAU quality criteria. Age-adjusted Charlson comorbidity index (ACCI), systemic inflammatory response index (SIRI), body mass index (BMI) ≥ 25 kg/m2, and neoadjuvant chemotherapy (NAC) were also evaluated. Multivariable regression models according to severe (CDC ≥ IIIb grade) complications were tested. Results Overall, 88.6% (187/211) patients experienced at least one intraoperative complication. Bleeding during cystectomy was the most common complication observed (81.5% [172/211]). Severe intraoperative complications (EAUiaiC grade > 2) were recorded in 8 patients. Overall, 521 postoperative complications were recorded. Overall, 69.6% of the patients experienced complications. Thirty-nine patients suffered from most severe (CDC ≥ IIIb grade) complications. ACCI (OR: 1.492 [1.144–1.947], p = 0.003), SIRI (OR: 1.279 [1.029–1.575], p = 0.031), BMI (OR: 3.62 [1.58–8.29], p = 0.002), and NAC (OR: 0.342 [0.133–0.880], p = 0.025) were significant independent predictive factors for 90-day most severe complications (CDC ≥ IIIb grade). Conclusions RC complications were reported within a standardized manner, concordant with the ICARUS and Martin criteria and EAU guideline recommendations. Complication reporting seems to be improved with the use of standard methodology. Our results showed that ACCI, SIRI, and BMI ≥ 25 kg/m2 and the absence of NAC were significant predictive factors for most severe complications.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Reporting perioperative complications of radical cystectomy: the influence of using standard methodology based on ICARUS and EAU quality criteria

et al. 2023

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“…The CCI, a composite score depicting all complications following an operation, was closely related to PLOS, medical expense, and duration in the ICU. Perhaps surprisingly, Hass et al [19] found that minor complications, as opposed to the most serious ones, were more responsible for the overall medical burden and stress. In the present series, 21 (16.3%) patients developed major complications (CDC ≥ III), whereas the proportion having high CCI accounted for 54.3%.…”

Section: Discussionmentioning

confidence: 98%

“…7 [34.8-39.4] g/L vs. 38.4 [36.4-40.5] g/L; p = 0.013) and higher CRP level (6.5 [4.2-34.6] g/L vs. 4.7 [2.9-9.8] g/L; p = 0.007) (Table 3). The incidences of CR-POPF (53.2% vs. 31.7%; p = 0.016), major complications (36.2% vs. 4.8%; p = 0.001), PLOS (22 [17-33] d vs. 17 [14][15][16][17][18][19][20][21][22][23] d; p = 0.002), and CCI score (34.8 [24.2-39.2] vs. 25.7 [19.4-32]; p = 0.001) were all increased in sarcopenic patients. Significant sex differences were found in the visceral obesity group (33 men vs. 5 women; p = 0.001) and the BMI was higher (26.1 ± 3.5 kg/m 2 vs. 22.1 ± 2.4 kg/m 2 ; p = 0.001).…”

Section: Relations Between Clinical Characteristics and Body Morphome...mentioning

confidence: 99%

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

et al. 2023

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Introduction Sarcopenia and visceral obesity have been identified as risk factors for postoperative complications following hepatobiliary and colon surgery. However, the correlation between body composition parameters and morbidity following pancreatectomy remains unclear. This study aimed to assess the predictive value of body composition parameters measured from preoperative CT images for postoperative complications following pancreaticoduodenectomy(PD). Methods A retrospective study of patients who underwent PD between January 2018 and January 2021 was performed. Areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), total abdominal muscle area (TAMA) and mean muscle radio-attenuation were measured from preoperative CT images. Postoperative complications were categorized according to the Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) scores were calculated. Logistic regression analysis was performed to identify factors associated with clinically relevant postoperative pancreatic fistula (CR-POPF) and high CCI score (≥26.2). Results From the data collected on 129 study patients, sarcopenia, visceral obesity and myosteatosis were detected in 47 (36.4%), 38 (29.4%), and 50 (38.7%) patients, respectively. CR-POPF developed in 51(39.5%) patients, the overall median CCI score was 30.8 (22.6-36.2), and high CCI scores were identified in 70 (54.3%) patients. Multivariate analysis indicated sarcopenia and visceral obesity were independent risk variables for CR-POPF. Preoperative sarcopenia, visceral obesity, age, preoperative biliary drainage, and a positive culture of postoperative drainage were predictors of high CCI scores. Conclusion Sarcopenia and visceral obesity were significant predictors of CR-POPF and high CCI score. Preoperative body composition assessment by CT images may help to identify high-risk patients who undergo PD.

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Development and validation of a preoperative nomogram to predict lymph node metastasis in patients with bladder urothelial carcinoma

Yao

Sun

et al. 2023

J Cancer Res Clin Oncol

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Purpose Predicting lymph node metastasis (LNM) in patients with bladder urothelial carcinoma (BUC) before radical cystectomy aids clinical decision making. Here, we aimed to develop and validate a nomogram to preoperatively predict LNM in BUC patients. Methods Patients with histologically confirmed BUC, who underwent radical cystectomy and bilateral lymphadenectomy, were retrospectively recruited from two institutions. Patients from one institution were enrolled in the primary cohort, while those from the other were enrolled in the external validation cohort. Patient demographic, pathological (using transurethral resection of the bladder tumor specimens), imaging, and laboratory data were recorded. Univariate and multivariate logistic regression analyses were performed to explore the independent preoperative risk factors and develop the nomogram. Internal and external validation was conducted to assess nomogram performance. Results 522 and 215 BUC patients were enrolled in the primary and external validation cohorts, respectively. We identified tumor grade, infiltration, extravesical invasion, LNM on imaging, tumor size, and serum creatinine levels as independent preoperative risk factors, which were subsequently used to develop the nomogram. The nomogram showed a good predictive accuracy, with area under the receiver operator characteristic curve values of 0.817 and 0.825 for the primary and external validation cohorts, respectively. The corrected C-indexes, calibration curves (after 1000 bootstrap resampling), decision curve analysis results, and clinical impact curves demonstrated that the nomogram performed well in both cohorts and was highly clinically applicable. Conclusion We developed a nomogram to preoperatively predict LNM in BUC, which was highly accurate, reliable, and clinically applicable.

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The comprehensive complication index is associated with a significant increase in complication severity between 30 and 90 days after radical cystectomy for bladder cancer

Cited by 16 publications

References 20 publications

Reporting perioperative complications of radical cystectomy: the influence of using standard methodology based on ICARUS and EAU quality criteria

Reporting perioperative complications of radical cystectomy: the influence of using standard methodology based on ICARUS and EAU quality criteria

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

Development and validation of a preoperative nomogram to predict lymph node metastasis in patients with bladder urothelial carcinoma

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