Thirty-day Morbidity and Mortality after Radical Cystectomy in Carcinoma Urinary Bladder; A Single Centre Experience

Anwaar  Ahmad; Muhammad Rafiq Zafar; Adnan Ali; Omer  Riaz; Abdul Jabbar Arif; Abu Sufyan

doi:10.51253/pafmj.v73i6.7717

Authors

Anwaar Ahmad Department of Urology, Armed Forces Institute of Urology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan,
Muhammad Rafiq Zafar Department of Urology, Armed Forces Institute of Urology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Adnan Ali Department of Urology, Armed Forces Institute of Urology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Omer Riaz Department of Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Abdul Jabbar Arif Department of Urology, Armed Forces Institute of Urology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Abu Sufyan Department of Urology, Armed Forces Institute of Urology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v73i6.7717

Keywords:

Clavien-dindo grading system, Carcinoma urinary bladder, Radical cystectomy

Abstract

Objective: To determine the 30-day morbidity and mortality after radical cystectomy in carcinoma urinary bladder using a
validated system.

Study Design: Retrospective longitudinal study.

Place and Duration of study: Armed Forces Institute of Urology, Rawalpindi Pakistan, from Jun 2016 to Jul 2021.

Methodology: After Institutional Ethical Review Board approval, data of all patients of carcinoma urinary bladder who
underwent radical cystectomy during five years at Armed Forces Institute of Urology, was collected. Data was retrieved
retrospectively from the hospital operative database, indoor patient records and by contacting the patients on their given
telephone numbers.

Results: In the study population (n=39), a male preponderance was found (36,92.3%). Mean age was 56.7±8.96 years (range 32-72). 26(66.7%) patients were smokers and 16(41%) received neoadjuvant chemotherapy. 9(23.7%) patients had Clavien-DindoGrade-I complications, 6(15.38%) had Grade-II, 2(5.12%) had Grade- IIIA, 2(5.12%) Grade IIIB, 1(2.56%) Grade-IVA, 1(2.56%)had Grade IVB, 2(5.12%) had Grade V complications. The total complications were 23(58.97%), and 16(41.03%) patients had nopost-operative complications. 21(53.85%) patients had less than 14 days post-op operative hospital stay, and 18(46.15%) hadmore than 14 days post-op operative hospital stay.

Conclusion: Radical cystectomy is still associated with high early post-op mortality and morbidity. Careful patient selection
and thorough counselling before the procedure are very important.

Downloads

Download data is not yet available.

References

Andrea M, Riccardo C, Riccardo T, Giorgio G, Simone A,Mohammad A, et al. Patterns and predictors of recurrence after

open radical cystectomy for bladder cancer: A comprehensive review of literature. World J Urol 2018; 36: 157-170.

https://doi: 10.1007/s00345-017-2115-4.

Beat R, George N. Standard cystectomy fits all: truth or myth?Transl Androl Urol 2015; 4(3): 254-260.https://doi.org/10.3978/j.issn.2223-4683.2015.04.08.

Tylor P, Andrew C, Greyson C, Ashok H. Semi-competing riskmodel to predict perioperative and oncologic outcomes after

radical cystectomy. Ther Adv Urol 2018; 10(11): 317-326.https://doi.org/10.1177/1756287218791412.

Susanne VL, Hanne T, Bente TJ, Bruno N, Peter T, Thordis T, et al.Complications and health-related quality of life after robotassisted versus open radical cystectomy: a systematic review andmeta-analysis of four RCTs. Syst Rev 2017; 6(1):150-161.https://doi: 10.1186/s13643-017-0547-y.

Fernando K, Juan P. High mortality rates after radical cystectomy:we must have acceptable protocols and consider the rationale ofcutaneous ureterostomy for high-risk patients. Int Braz J Urol2019; 45(6): 1090–1093.https://doi.org/10.1590/s1677-5538.ibju.2019.05.03.

Yasser O, Ahmed MH, Samer E, Mahmoud L. Acute kidney injuryfollowing radical cystectomy and urinary diversion: predictorsand associated morbidity. Int Braz J Urol 2018; 44(4): 726-733.https://doi.org/10.1590%2FS1677-5538.IBJU.2017.0283

Jacob T, Xiaosong M, Audrey R, Angela B, James S, Samir S, et al.Different models for prediction of radical cystectomy

postoperative complications and care pathways. Ther Adv Urol2019; 11(1): 1-10. http://doi.org/10.1177/1756287219875587.

Roger L, Michael M, Janet K, Neema N. Role of radical cystectomyin non-organ confined bladder cancer: A systematic review.Bladder Cancer 2018;4(1):31-40.http://doi.org/10.3233/BLC-170130

Junjic T, Junjic S, Guanghou F, Zhijic X, Xiaoyi C, Yue S, et al.Population-based outcome of muscle-invasive bladder cancer

following radical cystectomy: who can benefit from adjuvantchemotherapy? Transl Androl Urol 2021; 10(1): 356-373.

https://doi.org/10.21037%2Ftau-20-960.

Kevin LM, Grace K, Jure M, Melvin LK. Adjuvant treatmentfollowing radical cystectomy for muscle-invasive urothelial

carcinoma and variant histologies: Is there a role forradiotherapy? ESMO Open 2017; 1(6): e000123.http://doi.org/10.1136/esmoopen-2016-000123.

Toshihico M, Shuichi M, Masachi H, Tadahiro L, Tsutomu k,Kouji O, et al. Estimation of mortality and morbidity risk of

radical cystectomy using POSSUM and the Portsmouth predictorequation. Cent European J Urol 2015; 68(3): 270-276.

https://doi.org/10.5173/ceju.2015.636.

Todd M, Kirk A, Daniel A, Nedim R, Sharon E, Sam S, et al.Predicting the probability of 90-days survival in elderly bladder

cancer patients treated with radical cystectomy. J Urol 2011;186(3): 829-834. http://doi.org/10.1016/j.juro.2011.04.089.

Sophia L, Ulla N, Alicia M, Henrik K, Klaus B, Martin A, et al.Short-term morbidity and mortality following radical

cystectomy: a systematic review. BMJ Open 2021; 11(1): e043266.http://doi.org/10.1136/bmjopen-2020-043266.

Johar R, Hammad A, Faisal A, Zaheer A. Grading complicationfollowing radical cystectomy and ileal conduit for bladder cancerusing Clavien Grading System. J Coll Physicians Surg Pak 2012;22(7): 448-451.

Donat S. Standards of surgical complication reporting in urologiconcology: Time for a change. J Urol 2007; 69(2): 221-225.https://doi.org/10.1016/j.urology.2006.09.056.

Shabsigh A, Korets R, Vora K, Brooks C, Cronin A, Savage C, etal. Defining early morbidity of radical cystectomy for patientswith bladder cancer using a standardized reporting methodology. Eur Urol 2009; 55(1): 164-174.https://doi.org/10.1016/j.eururo.2008.07.031.

Ian B, Leilei X, Christopher W, Phillip D, Thomas J, Rachel R, etal. 30-day readmission after radical cystectomy: Identifying

targets for improvement using the phases of surgical care. CanUrol Assoc J 2019; 13(7): E190-201.

https://doi.org/10.5489/cuaj.5455.

Stimson C, Chang S, Barocas D. Early and late perioperativeoutcomes following radical cystectomy: 90 day readmission,morbidity and mortality in a contemporary series. J Urol 2010;184: 1296-1300. https://doi.org/10.1016/j.juro.2010.06.007.

Ahmed S, Fabiano S, Alice D, Simon T, Wassim K, Armen G.Postoperative mortality and complications after radical

cystectomy for bladder cancer in Quebec: A population-basedanalysis during the years 2000-2009. Can Urol Assoc J 2014; 8(7):259-267. http://doi.org/10.5489/cuaj.1997.