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SIU 2018:  Finetuning Estimates of Short-term Morbidity After Radical Cystectomy: A rigorous Approach for Assessing 30-day Adverse Events

Seoul, South-Korea (UroToday.com) In this work, Dr. Malte and colleagues presented a study attempting to improve the short-term morbidity after racial cystectomy. According to the authors, there are no clinical guidelines defining what surgeons need to report on perioperative complications for urologic procedures. In this study the authors aimed to perform a rigorous standardized assessment of the 30-day morbidity following radical cystectomy, with the goal to create a catalogue of procedure-specific complications. The aim of the catalogue is to characterize most common adverse effects, and eventually compare it to known validated complication recording system.  These include the Clavien-Dindo scoring system, which considers the highest-grade complication, and the comprehensive complication index (CCI), recording all complications into a single formula, reflecting the overall perioperative burden.

A total of 489 patients undergoing radical cystectomy and pelvic lymph node dissection for urinary bladder cancer between 2009 and 2017 were included in the analysis. All complications occurring within 30 days of the procedure were analyzed. Most of the complications were Clavien Dindo Grade 2. A total of 22.2% of the complications involved the genitourinary system, 20.6% involved the gastrointestinal system, 18.7% were infectious complications, 17.6% were defined as miscellaneous, 7.6% were related to bleeding, 5.3% were cardiac complications, 3.9% were wound related and 1.9% were pulmonary complications. Elaborate details of all complications were presented in the poster using the CCI.

The authors concluded that short term morbidity following radical cystectomy is notably higher than anticipated. There is an urgent need for a universal consensus on procedure-specific definitions of adverse events through usage of expert panels. The implementation of the CCI prevents under-staging of all perioperative complications and may improve comparability across various centers. It may also serve as a basis for defining benchmarks after radical cystectomy for bladder urothelial carcinoma.

Presented by:  Malte W. Vetterlein, Hamburg, Germany

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre  Twitter: @GoldbergHanan at the 38th Congress of the Society of International Urology - October 4- 7, 2018 - Seoul, South Korea