Reporting perioperative complications of radical cystectomy: the influence of using standard methodology based on ICARUS and EAU quality criteria

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Çınar N. B., Yılmaz H., Avci I. E., Çakmak K., Teke K., Dillioğlugil Ö.

World Journal of Surgical Oncology, vol.21, no.1, 2023 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 21 Issue: 1
  • Publication Date: 2023
  • Doi Number: 10.1186/s12957-023-02943-9
  • Journal Name: World Journal of Surgical Oncology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, MEDLINE, Directory of Open Access Journals
  • Keywords: Charlson comorbidity index, Icarus criteria, Inflammatory-nutritional markers, Intraoperative complication, Martin criteria, Open radical cystectomy, Systemic inflammatory response index, RENAL-CELL CARCINOMA, BLADDER-CANCER, RESPONSE INDEX, MORTALITY, SCORE
  • Open Archive Collection: AVESIS Open Access Collection
  • Kocaeli University Affiliated: Yes

Abstract

Purpose: We aimed to evaluate perioperative complications of radical cystectomy (RC) by using standardized methodology. Additionally, we identified independent risk factors associated with perioperative complications. Materials and methods: We retrospectively analyzed 30-day and 90-day perioperative complications of 211 consecutive RC patients. The intraoperative and postoperative complications were defined according to Clavien-Dindo classification (CDC) and reported based on the ICARUS criteria, Martin, and EAU quality criteria. Age-adjusted Charlson comorbidity index (ACCI), systemic inflammatory response index (SIRI), body mass index (BMI) ≥ 25 kg/m2, and neoadjuvant chemotherapy (NAC) were also evaluated. Multivariable regression models according to severe (CDC ≥ IIIb grade) complications were tested. Results: Overall, 88.6% (187/211) patients experienced at least one intraoperative complication. Bleeding during cystectomy was the most common complication observed (81.5% [172/211]). Severe intraoperative complications (EAUiaiC grade > 2) were recorded in 8 patients. Overall, 521 postoperative complications were recorded. Overall, 69.6% of the patients experienced complications. Thirty-nine patients suffered from most severe (CDC ≥ IIIb grade) complications. ACCI (OR: 1.492 [1.144–1.947], p = 0.003), SIRI (OR: 1.279 [1.029–1.575], p = 0.031), BMI (OR: 3.62 [1.58–8.29], p = 0.002), and NAC (OR: 0.342 [0.133–0.880], p = 0.025) were significant independent predictive factors for 90-day most severe complications (CDC ≥ IIIb grade). Conclusions: RC complications were reported within a standardized manner, concordant with the ICARUS and Martin criteria and EAU guideline recommendations. Complication reporting seems to be improved with the use of standard methodology. Our results showed that ACCI, SIRI, and BMI ≥ 25 kg/m2 and the absence of NAC were significant predictive factors for most severe complications.