The occurrence of high-grade complications after radical cystectomy worsens oncological outcomes in patients with bladder cancer

  • Ryo YamashitaEmail author
  • Masafumi Nakamura
  • Akifumi Notsu
  • Akihito Hashizume
  • Hideo Shinsaka
  • Masato Matsuzazki
  • Masashi Niwakawa
Urology - Original Paper



Reports frequently describe the worsening of oncologic outcome in patients who developed high-grade complications after curative surgery for esophageal, gastric, and breast cancers. We investigated the extent of this correlation in patients with bladder cancer after radical cystectomy (RC).


During 2002–2017, we performed 326 RC and urinary diversion procedures and collected data regarding complications in these patients within 90 days postoperatively. We evaluated the severity of complications based on the modified Clavien–Dindo classification (grades 0–5). Grade ≥ 3 complications were considered high grade. After adjusting for confounding factors using a Cox regression model, we calculated the hazard ratios (HRs) for high-grade complications associated with recurrence-free survival (RFS) and cancer-specific survival (CSS).


During a median follow-up period of 61 months, 38 patients (12%) developed high-grade complications (grade ≥ 3). The main causes (76%) of high-grade complications were gastrointestinal and infection problems. The RFS and CSS differed significantly between patients with high-grade complications and those without complications. After adjusting for confounding factors in the multivariate analysis, high-grade complications remained a significant risk factor for both RFS [HR 2.11; 95% confidence interval (CI) 1.07–4.15, p = 0.030] and CSS (HR 2.74; 95% CI 1.05–7.14, p = 0.039).


High-grade complications after RC led to worse RFS and CSS outcomes, similar to those observed in patients with other cancers. A large-scale study is needed to further verify these findings, and discussions of knowledge and experiences are required to reduce the incidence of postoperative high-grade complications.


Urothelial carcinoma Radical cystectomy Complications Clavien–Dindo classification 



The authors thank Eiji Kikuchi for his supervision and insight.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest regarding this article.

Human and animal rights

This retrospective single-center study was approved by the ethical review committee of Shizuoka Cancer Center (Number 2255).

Informed consent

The requirement for informed consent was waived because of the retrospective nature of the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Ryo Yamashita
    • 1
    Email author
  • Masafumi Nakamura
    • 1
  • Akifumi Notsu
    • 2
  • Akihito Hashizume
    • 1
  • Hideo Shinsaka
    • 1
  • Masato Matsuzazki
    • 1
  • Masashi Niwakawa
    • 1
  1. 1.Division of UrologyShizuoka Cancer CenterShizuokaJapan
  2. 2.Clinical Research CenterShizuoka Cancer CenterShizuokaJapan

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