Complications After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
Por:
Johar, RS, Hayn, MH, Stegemann, AP, Ahmed, K, Agarwal, P, Balbay, MD, Hemal, A, Kibel, AS, Muhletaler, F, Nepple, K, Pattaras, JG, Peabody, JO, Redorta, JP, Rha, KH, Richstone, L, Saar, M, Schanne, F, Scherr, DS, Siemer, S, Stokle, M, Weizer, A, Wiklund, P, Wilson, T, Woods, M, Yuh, B, Guru, KA
Publicada:
1 jul 2013
Resumen:
Background: Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures.
Objective: To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology.
Design, setting, and participants: Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up.
Outcome measurements and statistical analysis: Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission.
Results and limitations: Forty-one percent (n = 387) and 48% (n = 448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1-2 in 29%, and grade 3-5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study.
Conclusions: Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Johar, RS:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Hayn, MH:
Maine Med Ctr, Portland, ME 04102 USA
Stegemann, AP:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Ahmed, K:
Guys & St Thomas Hosp, London SE1 9RT, England
Agarwal, P:
Henry Ford Hlth Syst, Detroit, MI USA
Balbay, MD:
Ankara Ataturk Training & Res Hosp, Ankara, Turkey
Hemal, A:
Wake Forest Univ, Winston Salem, NC 27109 USA
Kibel, AS:
Washington Univ, Sch Med, St Louis, MO USA
Muhletaler, F:
Henry Ford Hlth Syst, Detroit, MI USA
Emory Univ, Sch Med, Atlanta, GA USA
Nepple, K:
Washington Univ, Sch Med, St Louis, MO USA
Pattaras, JG:
Emory Univ, Sch Med, Atlanta, GA USA
Peabody, JO:
Henry Ford Hlth Syst, Detroit, MI USA
Redorta, JP:
Fundacio Puigvert, Barcelona, Spain
Rha, KH:
Yonsei Univ Hlth Syst, Severance Hosp, Seoul, South Korea
Richstone, L:
Arthur Smith Inst Urol, Long Isl City, NY USA
Saar, M:
Saarland Univ Clin, Homburg, Germany
Schanne, F:
Urol Associates Delaware, Wilmington, DE USA
Scherr, DS:
Weill Cornell Med Coll, New York, NY USA
Siemer, S:
Saarland Univ Clin, Homburg, Germany
Stokle, M:
Saarland Univ Clin, Homburg, Germany
Weizer, A:
Univ Michigan, Ann Arbor, MI 48109 USA
Wiklund, P:
Karolinska Univ, Stockholm, Sweden
Wilson, T:
City Hope Natl Med Ctr, Duarte, CA USA
Woods, M:
Loyola Univ, Med Ctr, Maywood, IL 60153 USA
Yuh, B:
City Hope Natl Med Ctr, Duarte, CA USA
Guru, KA:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
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