Complications After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
Complications After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
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DOI：
10.1016/j.eururo.2013.01.010
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发表时间：
2013-07-01
期刊：
影响因子：
23.4
通讯作者：
Guru, Khurshid A.
中科院分区：
文献类型：
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作者：
Johar, Raza S.;Hayn, Matthew H.;Guru, Khurshid A.
背景：并发症的报告是高度可变和非标准化的。因此，确定主要肿瘤手术的手术结果势在必行。目的：使用标准化和有效的报告方法描述机器人辅助根治性膀胱切除术（RARC）后的并发症。设计、设置和参与者：使用国际机器人机器人联盟（IRCC）数据库，我们确定了939名接受RARC的患者，有可用的并发症数据，结果测量和统计分析：根据纪念斯隆-凯特琳癌症中心（MSKCC）系统分析和分级并发症，并按器官系统定义和分层。次要结局包括确定预测并发症的术前和术中变量。使用逻辑回归模型来定义并发症和再入院的预测因素。结果和局限性：分别有41%（n = 387）和48%（n = 448）的患者在手术后30天和90天内出现并发症。最高级别的并发症为0级，52%，1-2级，29%，3-5级，19%的患者。胃肠道、感染和泌尿生殖系统并发症最常见（分别为27%、23%和17%）。在多变量分析中，年龄增长、新辅助化疗和接受输血分别是任何和高级别并发症的独立预测因素。30 d和90 d死亡率分别为1.3%和4.2%。作为一个多机构的数据库，在病人的选择，操作标准，术后管理和并发症的报告的差异可以被认为是一个主要的限制study.Conclusions：手术后的发病率RARC是显着的，当使用标准化的报告方法。大多数并发症是低级别的。严格报告并发症是必要的，以倡导根治性膀胱炎（RC），并有助于患者咨询。(C)2013年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
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.