Radical cystectomy: a comparative evaluation of perioperative outcomes in patients with a complicated and uncomplicated postoperative period
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Abstract
The objective: to evaluate the diagnostic capabilities of general clinical and special methods of patient examination in predicting complications after the radical treatment of bladder cancer.
Patients and methods. This study is based on retrospective data from 126 patients who underwent open radical cystectomy (RCE), with one in three patients who had complications in postoperative period. All patients were divided into two groups according to the Clavien-Dindo classification to identify the predictors for the development of intra– and postoperative complications. The first group comprised of 82 (65,08%) patients with uncomplicated postoperative period. The second group consisted of 44 (34,92%) patients who developed complications of varying severity and required additional instrumental or surgical correction. Diagnostic possibilities of indicators of general clinical and special methods of examination of patients, available for quantitative registration, in predicting favorable and unfavorable outcomes and perioperative complications of RCE were evaluated.
Results. As a result of the comparative statistical analysis, 33 objective quantitative indicators characterizing the history of the disease and the objective status of patients showed no statistically significant differences. The age of the patients in the first group was on average 60,8±12,8 years and 58,2±9,5 years in the second group, р>0,05. This insignificant difference indicates that the elderly age >70 years, in combination with systemic diseases, limit the possibilities and the volume of surgical interventions. As a result the majority of the sampled patients aged 55–60 years. The average period from biopsy and muscle-invasive bladder cancer (MIBC) diagnosis before the RCE was 53,1±42,7 days in the group with uncomplicated postoperative period and 146,9±94,4 days in the group with complications. The indicator in the second group of patients exceeds the limit recommended by the EAU, where this period is limited to 90 days from the time of diagnosis of MIBC and exceeds the terms by 1.6 times.
Conclusions. The absence of statistically significant differences between all indicators in both groups indicates the need to create an algorithm to predict the development of postoperative complications for example – mathematical modeling.
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