Dynamics of indicators of early and late results of radical cystectomy depending on the time of the surgery from 2005 to 2016
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Abstract
The aim of the study: was to identify the risk factors for post-surgical complications in patients who underwent radical cystectomy (RCE).
Material and methods. We studied the immediate and long-term results of RCE due to bladder cancer (BC) (n=122). A retrospective analysis of the main indicators of the pre- and postoperative periods was done in chronological order, for all patients, including patients with non-cancer pathologies (n = 4).
Results. In 91% of patients RCE was performed for locally advanced and metastatic bladder cancer with more than 50% of patients having a comorbidity index of Charlson>4. Comorbidity Index showed a trend towards statistical significance, affecting the severity of post-surgical complications (r = 0, 14; p <0, 05). Postoperative complications were observed on average in 35% of patients. With the development of diagnostic capabilities and a more careful selection of patients as well as the improvement of surgical technologies, the level of post-surgical complications decreased from 78.3% in 2005 to 29.1% in 2015. External urinary diversion with continent stoma formation showed lower as compared to other methods derivation functional results, as evidenced by the presence of a weak direct correlation between continent diversion and presence of post-surgical complications.
The degree of severity of complications has significant correlation with surgical experience. Increase in the duration of the surgery, and large amounts of blood loss, along with the type of urine diversion and experience of the surgeon performing RCE, were significant predictors of complications, which was confirmed by monovariant logistical regression.
Conclusions. The correlational analysis showed deterioration tendency of post-surgical outcomes in patients who have three or more correlated pathologies, which increases the 10 year risk of death up to 44%, even without cancer-specific survival. Risk factors for post-surgical morbidity and poor prognosis of survival after RCE are heterotopic derivation, intraoperative blood loss of more than 1,000 ml, as well as the lack of experience of the surgeon.
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