Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort
Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort
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DOI：
10.1016/j.ejso.2013.03.008
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发表时间：
2013-07-01
期刊：
影响因子：
3.8
通讯作者：
Tubaro, A.
中科院分区：
文献类型：
--
作者：
De Nunzio, C.;Cindolo, L.;Tubaro, A.
简介：根治性膀胱切除术（RC）和尿流改道术（UD）后并发症的标准化报告方法对于评估与该手术相关的发病率是必要的，以评估改良的Clavien分类系统（CCS）在膀胱癌患者的真实的生活队列中对RC和UD的围手术期并发症进行分级。对2011年4月至2012年3月在意大利19家中心接受RC和UD治疗的连续患者系列进行了评价。根据改良CCS记录并发症。结果显示为每个级别的并发症发生率。结果：结果与局限性：共纳入467例患者。中位年龄为70岁（范围35-89岁）。UD包括原位新膀胱术112例，回肠代膀胱术217例，输尿管皮肤造口术138例。在302例患者中观察到415例并发症，分类为Clavien I型（109例患者）或I型（220例患者）; Clavien IIIa型（45例患者），IIIb型（22例患者）; IV型（11例患者）和V型（8例患者）。输尿管皮肤造口术患者CCS>= IIIa型的发生率较低（8%）（p = 0.03）。较长的手术时间是CCS ≥ III的独立危险因素（OR：1.005; CI：1.002-1.007/min; p = 0.0001）。结论：在我们的研究中，与既往经验相比，RC与显著的发病率（65%）和死亡率降低（1.7%）相关。改良CCS代表了一种易于应用的工具，可以更客观和详细地对RC和UD的并发症进行分类。(C)2013爱思唯尔有限公司保留所有权利。
Introduction: Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer.Materials and methods: A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis.Results: Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or It (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type >= IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS >= III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001).Conclusions: In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way. (C) 2013 Elsevier Ltd. All rights reserved.