Вестник урологии (Jul 2019)
Radical cystectomy for bladder cancer: early and late postoperative complications
Abstract
Background. Treatment of patients with bladder cancer remains one of the most pressing problems of oncourology. It is important to understand that the risks caused by the radical cystectomy are determined not only and even not so much by the technical difficulties of removal of the bladder, as by the somatic status of the patient who needs cystectomy. It is important to understand that radical cystectomy and urine derivation are essentially two stages of a single surgery intervetion. However, in the publications describing postoperative cystectomy complications often ignore the fact that the maximum number of complications develops and is associated with the complexity of the urinary diversion method. In a relatively recent long-term study on the results of radical cystectomy, the authors reported a 3% postoperative mortality rate and a 28% level of early postoperative complications (within 3 months after surgery). The authors paid attention to the fact that late complications was more often caused by the urinary diversion methods, whereas early complications are more often associated with radical cystectomy. In general, it is determined that morbidity and mortality are lower the more experience the clinic staff and the surgeon have in terms of patient management. The combination of these factors causes a slower recovery and a longer postoperative day. Despite the decrease in mortality, the level of complications of this procedure remains high even in the best centers of the world.Objective. Assessment of the prerequisites for the development of complications after radical cystectomy using different methods of urine diversion.Materials and methods. Oncological treatment results of 458 patients with bladder tumors were subjected to a detailed analysis.Results. The number of patients with comorbidities was significantly pronounced and noted in practically every patient (381 patients - 83.1%). At the same time, it was found that in the whole group of patients the average value of the Charlson's comorbidity index corrected for age turned out to be 2.6 ± 1.6 (from 0 to 8). Early postoperative complications were detected in 197 patients (43.0%). Early complications NOT associated with urinary diversion prevailed - 36.2%, while the frequency of early complications associated with urinary diversion was statistically significantly less on average 3 times and amounted 12.9%. The incidence of late postoperative complications (associated and NOT associated with the derivation of urine) was generally lower compared to early complications by almost 5 times (9.1%). At the same time, unlike the early postoperative period, among the late postoperative complications, mainly complications associated with the urine diversion of were recorded in 6.5% of cases. It is important that in the studied group of patients were recorded predominantly mild and moderate degrees of complication (Clavien-Dindo I-II) and amounted 41.7%.Conclusion. Obviously, radical cystectomy with urinary diversion are complex surgery with expected high rates of postoperative complications. In this regard, these indicators along with functional and oncological results should be taken into account when discussing a treatment strategy. Early postoperative complications are mainly related to technique of radical cystectomy performing, whereas late complications are more often due to used method of urinary diversion, while high indicators of the planned long-term survival indicate that it is not necessary to perform radical cystectomy. Thus, our findings unequivocally confirm the opinion of international experts and most researchers that achieving optimal optimal results in performing radical cystectomy with urinary intestinal diversion, maximizing morbidity and postoperative lethality is possible only with the accumulation of sufficient experience in this operation types.
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