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542 First national population-based register of complications after radical cystectomy – results from the Swedish cystectomy registry
Title
542
First national population-based register of complications after radical cystectomy – results from the Swedish cystectomy registry Eur Urol Suppl 2015;14/2;e542
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Jerlström T.1 , Hagberg O.2 , Steering Committee of the Swedish Cystectomy Registry, Sweden 1 School
of Health and Medical Sciences, Dept. of Urology, Örebro, Sweden, 2 RCC, Regional Cancer Center South, Lund, Sweden
INTRODUCTION & OBJECTIVES: Radical cystectomy with pelvic lymph node dissection and urinary diversion is a complex and challenging procedure with a considerable complication rate and even postoperative mortality. MATERIAL & METHODS: In the national population-based Swedish cystectomy registry perioperative parameters and early complications graded according to Clavien up to 90 postoperative days are registered. During the first three years (2011-2013) 1010 patients were included representing 76% of all cystectomies performed due to bladder cancer from the 22 hospitals nationwide performing the procedure, according to the Swedish National Board of Health and Welfare. There was a gradual increase in coverage, from 72% in 2011 to 79% in 2013. The median age in the study population, of whom 76% were males, was 70 years (Inter Quartile Range, IQR 65-76) and 36% of the patients staged cT2-T4 received neoadjuvant chemotherapy. RESULTS: The surgery was performed as open (82%) or robotic assisted laparoscopy (18%) with an increased use of the latter from 6% 2011 to 28% 2013. Ileal conduit was the dominating urinary diversion (85%) and another 12% received an orthotopic neobladder. Median estimated blood loss was 800 ml (IQR 400-1500) and operating time 325 minutes (IQR 266-390). Length of stay was median 14 days (IQR 11-17) and 25% of the patients were readmitted unscheduled within 90 days of surgery. Blood transfusions were given to 44% perioperatively, 50% at open operations and 14% at robotic. At least one complication was registered in 47% of the patients, with highest Clavien grade 1-2, 3, 4 and 5 reported in 26%, 16%, 3% and 2% of the patients, respectively, with no significant difference between open and robotic assisted operation. The dominating causes of complications were infectious 26%, abdominal wall/stoma 11%, gastrointestinal 8%, urinary tract 5% and cardiovascular 5%. Reoperations were performed at least once in 12% of the patients. The 90 day mortality was 5,1% of which 1,6% were cancer specific, thus leaving a possible 3,5 % surgery specific mortality. CONCLUSIONS: Complications occurred in 47% of the patients, of whom 21% suffered from high grade and 26% from low grade complications. The proportion of robotic assisted operations increased over time, and these patients had less estimated blood loss compared to open surgery, but there were no difference regarding complications.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/542.html[19/02/2015 08:15:35]
542
First national population-based register of complications after radical cystectomy – results from the Swedish cystectomy registry Eur Urol Suppl 2015;14/2;e542
Print! Print!
Jerlström T.1 , Hagberg O.2 , Steering Committee of the Swedish Cystectomy Registry, Sweden 1 School
of Health and Medical Sciences, Dept. of Urology, Örebro, Sweden, 2 RCC, Regional Cancer Center South, Lund, Sweden
INTRODUCTION & OBJECTIVES: Radical cystectomy with pelvic lymph node dissection and urinary diversion is a complex and challenging procedure with a considerable complication rate and even postoperative mortality. MATERIAL & METHODS: In the national population-based Swedish cystectomy registry perioperative parameters and early complications graded according to Clavien up to 90 postoperative days are registered. During the first three years (2011-2013) 1010 patients were included representing 76% of all cystectomies performed due to bladder cancer from the 22 hospitals nationwide performing the procedure, according to the Swedish National Board of Health and Welfare. There was a gradual increase in coverage, from 72% in 2011 to 79% in 2013. The median age in the study population, of whom 76% were males, was 70 years (Inter Quartile Range, IQR 65-76) and 36% of the patients staged cT2-T4 received neoadjuvant chemotherapy. RESULTS: The surgery was performed as open (82%) or robotic assisted laparoscopy (18%) with an increased use of the latter from 6% 2011 to 28% 2013. Ileal conduit was the dominating urinary diversion (85%) and another 12% received an orthotopic neobladder. Median estimated blood loss was 800 ml (IQR 400-1500) and operating time 325 minutes (IQR 266-390). Length of stay was median 14 days (IQR 11-17) and 25% of the patients were readmitted unscheduled within 90 days of surgery. Blood transfusions were given to 44% perioperatively, 50% at open operations and 14% at robotic. At least one complication was registered in 47% of the patients, with highest Clavien grade 1-2, 3, 4 and 5 reported in 26%, 16%, 3% and 2% of the patients, respectively, with no significant difference between open and robotic assisted operation. The dominating causes of complications were infectious 26%, abdominal wall/stoma 11%, gastrointestinal 8%, urinary tract 5% and cardiovascular 5%. Reoperations were performed at least once in 12% of the patients. The 90 day mortality was 5,1% of which 1,6% were cancer specific, thus leaving a possible 3,5 % surgery specific mortality. CONCLUSIONS: Complications occurred in 47% of the patients, of whom 21% suffered from high grade and 26% from low grade complications. The proportion of robotic assisted operations increased over time, and these patients had less estimated blood loss compared to open surgery, but there were no difference regarding complications.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/542.html[19/02/2015 08:15:35]