Using the National Inpatient Sample (2006–2019), we conducted a large retrospective analysis to evaluate whether CLD influences in-hospital outcomes after radical cystectomy with ileal conduit urinary diversion.5 To reduce confounding, we performed a 1:10 propensity score matching, adjusting for relevant demographic and clinical characteristics, followed by multivariable regression analyses.
Our study demonstrates that patients with CLD experience significantly higher rates of adverse in-hospital outcomes, including critical care therapies and mortality, compared with patients without CLD. These findings highlight that CLD is not only a background comorbidity but an independent determinant of surgical vulnerability.
From a clinical perspective, this emphasizes the importance of carefully assessing liver function before radical cystectomy, involving multidisciplinary management, and tailoring perioperative strategies to mitigate risk. In addition, our results raise the question of whether enhanced recovery protocols, optimization of nutritional status, and strict perioperative monitoring may be particularly beneficial in this fragile subset of patients.
Ultimately, our work underscores the need for increased awareness of liver disease in bladder cancer surgery and supports future prospective studies to refine risk stratification and improve outcomes for these high-risk patients.
Written by: Federico Polverino, MD, Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
References:
- Muscle-invasive and Metastatic Bladder Cancer - Uroweb [Internet]. [citato 26 febbraio 2025]. Disponibile su: https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer
- Chua KJ, Patel HV, Srivastava A, Doppalapudi SK, Lichtbroun B, Patel N, et al. Annual trends of cystectomy complications: A contemporary analysis of the NSQIP database. Urol Oncol. settembre 2023;41(9):390.e19-390.e26.
- Di Bello F, Rodriguez Peñaranda N, Marmiroli A, Longoni M, Falkenbach F, Chi Le Q, et al. Robot-Assisted Versus Open Radical Cystectomy: Comparison of Adverse In-Hospital Outcomes. J Surg Oncol. 28 marzo 2025;
- Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol [Internet]. 1 agosto 2023 [citato 26 febbraio 2025];79(2):516–37. Disponibile su: https://www.journal-of-hepatology.eu/article/S0168-8278(23)00194-0/fulltext
- Polverino F, Marmiroli A, Longoni M, Le QC, Falkenbach F, Nicolazzini M, et al. The Effect of Chronic Liver Disease on Adverse In-Hospital Outcomes After Radical Cystectomy and Ileal Conduit Urinary Diversion. Ann Surg Oncol [Internet]. 20 agosto 2025 [citato 27 agosto 2025]; Disponibile su: https://doi.org/10.1245/s10434-025-18032-y