The occurrence of high-grade complications after radical cystectomy worsens oncological outcomes in patients with bladder cancer
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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.
KeywordsUrothelial 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).
The requirement for informed consent was waived because of the retrospective nature of the study.
- 1.Parekh DJ, Reis IM, Castle EP et al (2018) Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 391:2525–2536. https://doi.org/10.1016/S0140-6736(18)30996-6 CrossRefPubMedGoogle Scholar
- 4.Fujiya K, Tokunaga M, Mori K et al (2016) Long-term survival in patients with postoperative intra-abdominal infectious complications after curative gastrectomy for gastric cancer: a propensity score matching analysis. Ann Surg Oncol 23:809–816. https://doi.org/10.1245/s10434-016-5577-5 CrossRefPubMedGoogle Scholar
- 5.Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W (2017) Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg 41:277–284. https://doi.org/10.1007/s00268-016-3761-1 CrossRefPubMedGoogle Scholar
- 8.Salvans S, Mayol X, Alonso S et al (2014) Postoperative peritoneal infection enhances migrations and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg 260:939–944. https://doi.org/10.1097/SLA.0000000000000958 CrossRefPubMedGoogle Scholar
- 11.Roth B, Birkhäuser FD, Zehnder P, Burkhard FC, Thalmann GN, Studer UE (2011) Readaptation of the peritoneum following extended pelvic lymphadenectomy and cystectomy has a significant beneficial impact on early postoperative recovery and complications: results of a prospective randomized trial. Eur Urol 59:204–210. https://doi.org/10.1016/j.eururo.2010.10.030 CrossRefPubMedGoogle Scholar