Comparative study of postoperative complications after radical cystectomy during the past two decades in Japan: Radical cystectomy remains associated with significant postoperative morbidities.

During the past 2 decades, in order to improve perioperative and oncological outcomes, a minimally invasive approach, neoadjuvant chemotherapy (NAC), and an enhanced postoperative recovery program after surgery have been introduced into routine clinical practice of radical cystectomy (RC). Our aim was to examine the differences in clinical practice and postoperative complications after RC by comparing our previous and current cohorts.

A retrospective multi-institutional study. We collected all complications within 90 days after surgery between 2011 and 2017 (current cohort), and categorized them according to a standardized methodology. Then, we compared the outcomes with those in our previous study (previous cohort, 1997-2010). A multivariate logistic regression model was utilized to determine predictors of complications in the current cohort.

A total of 838 patients were newly collected (current cohort), and 919 from the previous cohort were included in the subsequent analyses. In the current cohort, the rate of performing NAC was significantly higher (13% vs. 4%, respectively, P < 0.0001), and 26% (222/838) underwent laparoscopic RC (LRC, without robotic assistance: n = 210, with robotic assistance: n = 12). There was no significant difference in the overall complication [69% (580/838) vs. 68% (629/919), respectively, P = 0.7284] or major complication (Grades 3-5) [25% (211/838) vs. 22% (201/919), respectively, P = 0.1022] rates between the 2 cohorts. In both cohorts, the most frequent categories were infectious, gastrointestinal, wound-related, and genitourinary. In the current cohort, the performance status (odds ratio, OR = 2.11, P = 0.0013) and operative time (OR = 1.003, P = 0.0016) remained significant predictors of major complications. NAC was not associated with any or major complications.

Surgical complications related to RC still remain significant problems, despite the recent improvements in surgical techniques and perioperative care. NAC did not increase the complications.

Urologic oncology. 2021 Oct 26 [Epub ahead of print]

Shuhei Yamada, Takashige Abe, Ataru Sazawa, Hidenori Katano, Hidetaka Suzuki, Ichiro Takeuchi, Junji Ishizaki, Keita Minami, Ken Morita, Kunihiko Tsuchiya, Norikata Takada, Shintaro Maru, Shuhei Ishikawa, Soshu Sato, Takafumi Kawazu, Takanori Yamashita, Takenori Ono, Tango Mochizuki, Tomoshige Akino, Yoshihiro Sasaki, Yuichiro Shinno, Jun Furumido, Haruka Miyata, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Nobuo Shinohara

Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan., Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: ., Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.

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