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The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology

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Abstract

Purpose

To analyze postoperative complications after laparoscopic radical cystectomy (LRC) and evaluate its risk factors in a large prospective cohort built by the ESUT across European centers involved in minimally invasive urology in the last decade.

Methods

Patients were prospectively enrolled, and data were retrospectively analyzed. Only oncologic cases were included. There were no formal contraindications for LRC: Also patients with locally advanced tumors (pT4a), serious comorbidities, and previous major abdominal surgery were enrolled. All procedures were performed via a standard laparoscopic approach, with no robotic assistance. Early and late postoperative complications were graded according to the modified Clavien–Dindo classification. Multivariate logistic regression was performed to explore possible risk factors for developing complications.

Results

A total of 548 patients were available for final analysis, of which 258 (47 %) experienced early complications during the first 90 days after LRC. Infectious, gastrointestinal, and genitourinary were, respectively, the most frequent systems involved. Postoperative ileus occurred in 51/548 (9.3 %) patients. A total of 65/548 (12 %) patients underwent surgical re-operation, and 10/548 (2 %) patients died in the early postoperative period. Increased BMI (p = 0.024), blood loss (p = 0.021), and neoadjuvant treatment (p = 0.016) were significantly associated with a greater overall risk of experiencing complications on multivariate logistic regression. Long-term complications were documented in 64/548 (12 %), and involved mainly stenosis of the uretero-ileal anastomosis or incisional hernias.

Conclusions

In this multicenter, prospective, large database, LRC appears to be a safe but morbid procedure. Standardized complication reporting should be encouraged to evaluate objectively a surgical procedure and permit comparison across studies.

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Acknowledgments

The authors would like to thank Omar M. Aboumarzouk, Daphnée Lizée, Ali Serdar Goezen, Konstantin Godin, Lorenzo Rocchini, Hamin Slaoui, A. Sonneveld, Verma Prateek, and Alexandra Masson-Lecomte for their strong work in data gathering and for helping to build the present database of patients undergoing laparoscopic cystectomy.

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Authors and Affiliations

  1. Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium

    Simone Albisinni

  2. Department of Urology, Clinique Saint Augustin, Bordeaux, France

    Marco Oderda & Thierry Piechaud

  3. Department of Urology, Maxima Medisch Centrum, Eindhoven, The Netherlands

    Laurent Fossion

  4. Department of Urology, Ospedale Luigi Sacco, Milan, Italy

    Virginia Varca & Franco Gaboardi

  5. Department of Urology, SLK Kliniken, Heilbronn, Germany

    Jens Rassweiler

  6. Department of Urology, Institut Montsouris, Paris, France

    Xavier Cathelineau & Rafael Sanchez-Salas

  7. Department of Urology, Jagiellonian University, Kraków, Poland

    Piotr Chlosta

  8. Department of Urology, CHU Henri Mondor, Creteil, France

    Alexandre De la Taille & Laurent Salomon

  9. Department of Urology, East Sussex Healthcare NHS Trust, Eastbourne, UK

    Peter Rimington

  10. Department of Urology, University of Leipzig, Leipzig, Germany

    Jens-Uwe Stolzenburg

  11. Department of Urology, University of Heidelberg, Heidelberg, Germany

    Dogu Teber

  12. Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 121, Brussels, Belgium

    Simone Albisinni & Roland Van Velthoven

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  1. Simone Albisinni
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Correspondence to Simone Albisinni.

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The authors declare they have no conflict of interests.

Ethical standards statement

The present study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Patients gave their informed consent prior to their inclusion in the study.

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Albisinni, S., Oderda, M., Fossion, L. et al. The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology. World J Urol 34, 149–156 (2016). https://doi.org/10.1007/s00345-015-1633-1

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  • DOI: https://doi.org/10.1007/s00345-015-1633-1

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