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Komplikationen nach Ileumconduitanlage

Harnableitungsspezifische Komplikationen nach radikaler Zystektomie

Complications after ileal conduit

Urinary diversion-associated complications after radical cystectomy

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Zusammenfassung

Fragestellung

Wir untersuchten die Rate harnableitungsspezifischer Komplikationen nach radikaler Zystektomie (RC) und Ileumconduitanlage (IC-Anlage).

Patienten und Methoden

305 Blasentumorpatienten nach RC und IC-Anlage konnten eingeschlossen werden (06/2003–12/2010). IC-Komplikationen (parastomale Hernien, Ureterimplantations- und IC-Stenosen, IC-Blutungen, Urolithiasis, fieberhafte Harnwegsinfekte, Niereninsuffizienz) wurden nach Clavien-Dindo (CDC) erfasst. Kaplan-Meier-Kurven wurden berechnet. Uni- und multivariable Cox’sche Regressionsanalysen mit rückwärtsgerichteter Selektion testeten den Effekt von Alter, abdomineller/pelviner Radiatio oder Voroperation vor RC, Adipositas, Komorbiditäten und fortgeschrittenem Tumorstadium auf das Auftreten einer hochgradigen IC-Komplikation (CDC ≥ III) sowie die Durchführung einer IC-Revision.

Ergebnisse

32,7 und 13,4 % unserer Patienten entwickelten eine IC-Komplikation (CDC ≥ I) und eine hochgradige IC-Komplikation (CDC ≥ III). 14,8 %, 4,6 % und 4,3 % entwickelten eine parastomale Hernie, eine Ureterimplantations- oder eine IC-Stenose. 10,5 % der Patienten mussten sich einer IC-Revision unterziehen (medianes Follow-up 19,5 Monate, IQA 7-47). Die geschätzte IC-Komplikationsrate nach 5 Jahren lag bei 52 % (CDC ≥ I) und 22 % (CDC ≥ III). Die multivariable Analyse zeigte, dass vorbestrahlte (HR 4,33) adipöse (HR 2,24) Patienten nach längerer RC-Dauer (HR 1,01), einem Risiko für eine IC-Revision ausgesetzt sind. Adipositas (HR 2,49; alle p < 0,05) war ein Risikofaktor für hochgradige Komplikationen.

Diskussion

Das Risiko für eine hochgradige IC-Komplikation oder eine IC-Revision ist moderat. Vorbestrahlte, komorbide und adipöse Patienten haben ein erhöhtes Risiko für eine IC-Revison. Adipositas stellt zudem einen Risikofaktor für hochgradige IC-Komplikationen dar.

Abstract

Background

We analyzed complications associated with urinary diversion after radical cystectomy (RC) and ileal conduit (IC) for bladder cancer (BCa).

Patients and methods

A total of 305 BCa patients after RC with IC were included in the study (June 2003–December 2010). IC complications (peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, IC bleeding, urolithiasis, urinary infections, and renal insufficiency) were identified according to the Clavien–Dindo classification (CDC). Kaplan–Meier plots were generated. Uni- and multivariable Cox regression analyses with backward selection for prediction of high-grade complications (CDC ≥ III) and IC revision surgery were conducted; covariates included age, previous abdominal/pelvic radiation, body mass index (BMI), previous abdominal/pelvic surgery, comorbidities, and advanced tumor stage.

Results

An IC complication (CDC ≥ I) or a high-grade IC complication (CDC ≥ III) was experienced by 32.7 and 13.4 % of our cohort: 14.8 %, 4.3 %, 4.6 % developed a peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, respectively. IC revision was required by 10.5 % of patients (median follow-up 19.5 months, IQR 7–47 months). The estimated rate of IC complications at 5 years was 52 % (CDC ≥ I) and 22 % (CDC ≥ III). The final model of the multivariable analysis showed that patients with a history of previous radiation (HR 4.33), a BMI ≥ 30 (HR 2.24), or longer duration of surgery (HR 1.01; all p < 0.05) were at higher risk for IC revision surgery. A BMI ≥ 30 (HR 2.49, p = 0.011) was a risk factor for high-grade complications.

Conclusion

The risk of experiencing a high-grade IC complication is moderate. Previous radiation, obesity, and comorbidities represent risk factors for IC revision surgery. Moreover, obesity is a risk factor for high-grade complications.

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Abbreviations

AIC:

Aikaike Information Criterion

ASA:

American Society of Anesthesiologists Score

BMI:

Body-Mass-Index

CCI:

Charlson-Komorbiditätsindex

CDC:

Clavien-Dindo-Klassifikation

CI:

Konfidenzintervall

HR:

Hazard Ratio

HWI:

Harnwegsinfekte

IC:

Ileumconduit

ICU:

Intensive Care Unit

IMC:

Intermediate Care Unit

IQA:

Interquartilenabstand

NB:

Orthotope Neoblase

RC:

Radikale Zystektomie

Ref.:

Referenz

Literatur

  1. Hautmann RE, Abol-Enein H, Hafez K et al (2007) Urinary diversion. Urology 69(1 Suppl):17–49 (Epub 2007/02/07)

    Article  PubMed  Google Scholar 

  2. Stein JP, Lieskovsky G, Groshen S et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675

    CAS  PubMed  Google Scholar 

  3. Bricker EM (1950) Bladder substitution after pelvic evisceration. Surg Clin North Am 30(5):1511–1521 (Epub 1950/10/01)

    CAS  PubMed  Google Scholar 

  4. Witjes JA, Comperat E, Cowan NC et al (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792 (Epub 2014/01/01)

    Article  PubMed  Google Scholar 

  5. Roghmann F, Becker A, Trinh QD et al (2013) Updated assessment of neobladder utilization and morbidity according to urinary diversion after radical cystectomy: a contemporary US-population-based cohort. Can Urol Assoc J 7(9–10):E552–E560 (Epub 2013/09/27)

  6. Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–176

    Article  PubMed  Google Scholar 

  7. Novara G, De Marco V, Aragona M et al (2009) Complications and mortality after radical cystectomy for bladder transitional cell cancer. JURO 182(3):914–921

    Google Scholar 

  8. Novotny V, Hakenberg OW, Wiessner D et al (2007) Perioperative complications of radical cystectomy in a contemporary series. Eur Urol 51(2):397–402

    Article  PubMed  Google Scholar 

  9. Chang SS, Cookson MS, Baumgartner RG et al (2002) Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol 167:2012–2016

    Article  PubMed  Google Scholar 

  10. Aziz A, May M, Burger M et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66(1):156–163 (Epub 2014/01/07)

    Article  PubMed  Google Scholar 

  11. Autorino R, Quarto G, Di Lorenzo G et al (2009) Health related quality of life after radical cystectomy: comparison of ileal conduit to continent orthotopic neobladder. Eur J Surg Oncol 35(8):858–864 (Epub 2008/10/01)

    Article  CAS  PubMed  Google Scholar 

  12. Frich PS, Kvestad CA, Angelsen A (2009) Outcome and quality of life in patients operated on with radical cystectomy and three different urinary diversion techniques. Scand J Urol Nephrol 43(1):37–41 (Epub 2008/10/25)

    Article  PubMed  Google Scholar 

  13. Tanaka T, Kitamura H, Takahashi A et al (2005) Long-term functional outcome and late complications of Studer’s ileal neobladder. Jpn J Clin Oncol 35(7):391–394 (Epub 2005/06/25)

    Article  PubMed  Google Scholar 

  14. Roghmann F, Trinh QD, Braun K et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149 (Epub 2013/08/03)

    Article  PubMed  Google Scholar 

  15. Wittekind C, Hutter R et al (2007) TNM atlas: ilustrated guide to the TNM/pTNM classification of malignat tumors. Springer, Heidelberg

  16. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  17. Hens N, Aerts M, Molenberghs G (2006) Model selection for incomplete and design-based samples. Stat Med 25(14):2502–2520 (Epub 2006/04/06)

    Article  CAS  PubMed  Google Scholar 

  18. Shimko MS, Tollefson MK, Umbreit EC et al (2011) Long-term complications of conduit urinary diversion. J Urol 185(2):562–567 (Epub 2010/12/21)

    Article  PubMed  Google Scholar 

  19. Bartsch G, Gust K, Vallo S et al (2013) Cystectomy in the elderly patient. Urologe A 52(6):821–826 (Epub 2013/04/23. Zystektomie im Alter)

    Article  CAS  PubMed  Google Scholar 

  20. Roghmann F, Sukumar S, Ravi P et al (2013) Radical cystectomy in the elderly: national trends and disparities in perioperative outcomes and quality of care. Urol Int 92(1):27–34

    Article  PubMed  Google Scholar 

  21. Gore JL, Yu H-Y, Setodji C et al (2010) Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 116(2):331–339

    Article  PubMed Central  PubMed  Google Scholar 

  22. Madersbacher S, Schmidt J, Eberle JM et al (2003) Long-term outcome of ileal conduit diversion. J Urol 169(3):985–990 (Epub 2003/02/11)

    Article  PubMed  Google Scholar 

  23. Nastro P, Knowles CH, McGrath A et al (2010) Complications of intestinal stomas. Br J Surg 97(12):1885–1889 (Epub 2010/09/28)

    Article  CAS  PubMed  Google Scholar 

  24. Klinge U, Si ZY, Zheng H et al (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res 32(1):43–48 (Epub 2000/03/18)

    Article  CAS  PubMed  Google Scholar 

  25. Bodman CBM von, Roghmann F, Eggert T et al (2012) 1170 parastomal hernia repair follwing ileal conduit urinary diversion using a novel funnel mesh implant. J Urol 187(4):e474

    Article  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Roghmann, M. Gockel, J. Schmidt, J. Hanske, N. von Landenberg, B. Löppenberg, K. Braun, C. von Bodman, J. Pastor, J. Palisaar, J. Noldus und M. Brock geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie, Marien Hospital Herne, Ruhr-Universität Bochum, Widumerstr. 8, 44627, Herne, Deutschland

    F. Roghmann, M. Gockel, J. Schmidt, J. Hanske, N. von Landenberg, B. Löppenberg, K. Braun, C. von Bodman, J. Pastor, J. Palisaar, J. Noldus & M. Brock

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  1. F. Roghmann
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  2. M. Gockel
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  3. J. Schmidt
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  4. J. Hanske
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  5. N. von Landenberg
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  6. B. Löppenberg
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  7. K. Braun
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  8. C. von Bodman
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  9. J. Pastor
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  10. J. Palisaar
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  11. J. Noldus
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  12. M. Brock
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Correspondence to F. Roghmann.

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F. Roghmann und M. Gockel haben zu gleichen Teilen zu dieser Arbeit beigetragen.

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Roghmann, F., Gockel, M., Schmidt, J. et al. Komplikationen nach Ileumconduitanlage. Urologe 54, 533–541 (2015). https://doi.org/10.1007/s00120-015-3812-5

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  • DOI: https://doi.org/10.1007/s00120-015-3812-5

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