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Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-Stage Complete Urinary Tract Extirpation

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and the risk of major postoperative complications has not been systematically investigated.

Objective

The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE.

Methods

Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher’s exact test with Chi square and two-tailed t test were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications.

Results

In this population, 53 (65.4%) patients had Clavien grade 0–2 complications (‘no major complications’) and 28 (34.6%) patients had Clavien grade 3–5 complications (‘major complications’). Compared with the major complications group, patients in the no major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher preoperative serum albumin, and shorter duration of hospitalization (p < 0.05 for all). Major complications were more common in low-volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (odds ratio [OR] 6.25, 95% confidence interval [CI] 1.42–27.47; p = 0.015) and surgery by a provider who performed three or fewer cases during the study interval (OR 13.4, 95% CI 2.20–80.89; p = 0.005) were independent predictors for major complications.

Conclusions

High CCI should alert providers to increased probability of major complications, and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.

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Acknowledgement

The work was supported in part by Chang Gung Medical Foundation, Taiwan (CMRP G6F0521). The authors would like to thank Chia-Hao Chang for his supervision of the statistical analysis.

Disclosure

Yun-Ching Huang, Ying-Hsu Chang, Alan W. Shindel, Yin-Lun Chang, Jian-Hui Lin, Dong-Ru Ho, and Chih-Shou Chen have no conflicts of interest to declare.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan

    Yun-Ching Huang MD, PhD, Yin-Lun Chang MD, Jian-Hui Lin MD, Dong-Ru Ho MD & Chih-Shou Chen MD

  2. Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yun-Ching Huang MD, PhD

  3. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Ying-Hsu Chang MD

  4. Department of Urology, University of California at San Francisco, San Francisco, CA, USA

    Alan W. Shindel MD

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  1. Yun-Ching Huang MD, PhD
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  2. Ying-Hsu Chang MD
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  4. Yin-Lun Chang MD
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  5. Jian-Hui Lin MD
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Correspondence to Yun-Ching Huang MD, PhD.

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Huang, YC., Chang, YH., Shindel, A.W. et al. Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-Stage Complete Urinary Tract Extirpation. Ann Surg Oncol 25, 573–581 (2018). https://doi.org/10.1245/s10434-017-6251-2

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  • DOI: https://doi.org/10.1245/s10434-017-6251-2

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