Perioperative Complications and Oncologic Outcomes after Radical Cystectomy in End-Stage Renal Disease Patients with Bladder Cancer Obtained Using a Standardized Reporting System

• Published in: Cancers 2022-07, Vol.14 (14), p.3512
• Main Authors: Liu, Yu-Liang, Wu, Chun-Te, Hsu, Yu-Chao, Chen, Miao-Fen, Chen, Chih-Shou, Shi, Chung-Sheng, Huang, Yun-Ching
• Format: Article
• Language: English
• Subjects: Bladder cancer; Comorbidity; Dialysis; End-stage renal disease; Hemodialysis; Hospitalization; Invasiveness; Kidney diseases; Malignancy; Medical prognosis; Morbidity; Mortality; Multivariate analysis; Patients; Population; Regression analysis; Risk factors; Scintigraphy; Sex; Surgeons; Surgery; Surgical outcomes; Survival analysis; Tumors; Urothelial carcinoma
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14143512

Background: We investigated the use of a standardized reporting system to study perioperative complications and oncologic outcomes after radical cystectomy in end-stage renal disease (ESRD) patients with bladder cancer. Methods: We reviewed retrospective outcomes in 141 ESRD patients with bladder cancer who underwent radical cystectomy between 2004 and 2015. Complications were graded using the Clavien−Dindo classification system with 0−2 classified as “No Major Complications” and Clavien 3−5 as “Major Complications”. Low-volume surgeons were classified as those performing fewer than nine cases during the study. Fisher’s exact test along with the chi-squared test, two-tailed t tests, logistic regression, and the Cox proportional hazard model were used to evaluate all clinically meaningful covariates. Results: Ninety-nine (99, 70.2%) patients had no major complications, and forty-two (29.8%) patients had major complications. Patients in the major complications group were older, had a higher Charlson comorbidity index (CCI), and had a longer hospitalization duration than those in the no major complications group (all, p < 0.05). Major complications were also more common when the procedure was performed by low-volume surgeons (p = 0.003). In multivariate logistic regression models, CCI ≥ 5 (p = 0.006) and low-volume surgeon (p = 0.004) were independent predictors of major complications. According to multivariate analysis with the Cox hazards regression, male sex, age > 70 years, CCI ≥ 5, bladder cancer stage ≥ 3, lymphovascular invasion, and experiencing major complications were significant poor prognostic factors for overall survival (all, p < 0.05). Conclusions: Accurate reporting of complications is necessary for preoperative counseling, identifying modifiable risk factors, and planning risk mitigation strategies. High comorbidity and low-volume surgeons were interrelated as notable risk factors for major complications. In addition to tumor-related factors, male sex, older age, and major complications significantly influence overall survival.