The Early Complications And Risk Factors Following Radical Cystectomy And Orthotopic Diversion

Objective(s):To retrospectively review the risk factors associated with early complications following radical cystectomy and orthotopic diversion. And hope for providing several references prevent and reduce postoperative complications related to radical cystectomy and orthotopic diversion in future.Methods:The clinical data of 73 patients who had undergone orthotopic ileal neobladder or orthotopic sigmoid neobladder from January 2014 to December 2015 in the Second Affiliated Hospital of Kunming Medical University. According to the Postoperative Complication Grading System, retrospectively analysed in-hospital complications and subdivided these complications into different grade and category. Then, all the risk factors will be entered into multivariate logistic regression.Results:Of the 73 patients,42 (57.5%) developed at least 1 postoperative complication and 22 at least 2 complications. In the total of 77 subjects of early complications,29 (37.7%) subjects was minor complications,44(57.1%) subjects was moderate complications and 4 (5.2%) subjects was major complications during in hospital. The most frequently complications presented were infection-related events,gastrointistinal events and urine leakage. The frequences of other postoperative complications were lower than mentioned above.There is no statistic difference at histological type,pathologica stage,operative time and intestinal segments according to the results of the one-way analysis of variance(P>0.05).The incidence of the early complications rate correlated significantly with BMI score,blood loss,glutamic-pyruvic transaminase and CCI score.On the logistic regression analysis,the risk factors leading to postoperative complications were BMI score(OR=1.574, P=0.002),blood loss(OR=1.050, P=0.027)and CCI score(OR=1.127, P=0.040)Conclusion(s):1. Surgical morbidity following radical cystectomy and orthotopic diversion is significant even in the most experienced hands. But the rate of severe and lethal complications is acceptably low. The radical cystectomy and orthotopic diversion remains a safe treatment for the patients with muscle invasive bladder cancer.2. The most frequently complications presented were infection-related events,gastrointistinal events and urine leakage.There is no significant differences in the domestic and foreign literature.3. On the logistic regression analysis,the incidence of the early complications rate correlated significantly with BMI score,blood loss and CCI score.4. The preoperative intervention including that pay more attention in patients with higher BMI, treat and steady the blood sugar and other comrbidities condition, exclude the candidate with dangerous comrbidities, and measures during operation like excellent surgery techniques and blood transfusion in time may could reduce the complication rate effectively.