Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

C. De Nunzio, L. Cindolo, C. Leonardo, A. Antonelli, C. Ceruti, G. Franco, M. Falsaperla, M. Gallucci, M. Alvarez-Maestro, A. Minervini, V. Pagliarulo, P. Parma, S. Perdonà, A. Porreca, B. Rocco, L. Schips, S. Serni, M. Serrago, C. Simeone, G. SimoneR. Spadavecchia, A. Celia, P. Bove, S. Zaramella, S. Crivellaro, R. Nucciotti, A. Salvaggio, B. Frea, V. Pizzuti, L. Salsano, A. Tubaro

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Abstract

Introduction Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. Materials and methods A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. Results Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type ≥IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001). Conclusions In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.

Original languageEnglish
Pages (from-to)792-798
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume39
Issue number7
DOIs
Publication statusPublished - Jul 2013

Fingerprint

Urinary Diversion
Cystectomy
Ureterostomy
Morbidity
Skin
Operative Time
Urinary Bladder Neoplasms
Italy

Keywords

  • Bladder cancer
  • Clavien
  • Complications
  • Cystectomy
  • Urinary diversion

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort. / De Nunzio, C.; Cindolo, L.; Leonardo, C.; Antonelli, A.; Ceruti, C.; Franco, G.; Falsaperla, M.; Gallucci, M.; Alvarez-Maestro, M.; Minervini, A.; Pagliarulo, V.; Parma, P.; Perdonà, S.; Porreca, A.; Rocco, B.; Schips, L.; Serni, S.; Serrago, M.; Simeone, C.; Simone, G.; Spadavecchia, R.; Celia, A.; Bove, P.; Zaramella, S.; Crivellaro, S.; Nucciotti, R.; Salvaggio, A.; Frea, B.; Pizzuti, V.; Salsano, L.; Tubaro, A.

In: European Journal of Surgical Oncology, Vol. 39, No. 7, 07.2013, p. 792-798.

Research output: Contribution to journalArticle

De Nunzio, C, Cindolo, L, Leonardo, C, Antonelli, A, Ceruti, C, Franco, G, Falsaperla, M, Gallucci, M, Alvarez-Maestro, M, Minervini, A, Pagliarulo, V, Parma, P, Perdonà, S, Porreca, A, Rocco, B, Schips, L, Serni, S, Serrago, M, Simeone, C, Simone, G, Spadavecchia, R, Celia, A, Bove, P, Zaramella, S, Crivellaro, S, Nucciotti, R, Salvaggio, A, Frea, B, Pizzuti, V, Salsano, L & Tubaro, A 2013, 'Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort', European Journal of Surgical Oncology, vol. 39, no. 7, pp. 792-798. https://doi.org/10.1016/j.ejso.2013.03.008
De Nunzio, C. ; Cindolo, L. ; Leonardo, C. ; Antonelli, A. ; Ceruti, C. ; Franco, G. ; Falsaperla, M. ; Gallucci, M. ; Alvarez-Maestro, M. ; Minervini, A. ; Pagliarulo, V. ; Parma, P. ; Perdonà, S. ; Porreca, A. ; Rocco, B. ; Schips, L. ; Serni, S. ; Serrago, M. ; Simeone, C. ; Simone, G. ; Spadavecchia, R. ; Celia, A. ; Bove, P. ; Zaramella, S. ; Crivellaro, S. ; Nucciotti, R. ; Salvaggio, A. ; Frea, B. ; Pizzuti, V. ; Salsano, L. ; Tubaro, A. / Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort. In: European Journal of Surgical Oncology. 2013 ; Vol. 39, No. 7. pp. 792-798.
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abstract = "Introduction Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. Materials and methods A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. Results Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8{\%}) of CCS type ≥IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001). Conclusions In our study, RC is associated with a significant morbidity (65{\%}) and a reduced mortality (1.7{\%}) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.",
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T1 - Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

AU - De Nunzio, C.

AU - Cindolo, L.

AU - Leonardo, C.

AU - Antonelli, A.

AU - Ceruti, C.

AU - Franco, G.

AU - Falsaperla, M.

AU - Gallucci, M.

AU - Alvarez-Maestro, M.

AU - Minervini, A.

AU - Pagliarulo, V.

AU - Parma, P.

AU - Perdonà, S.

AU - Porreca, A.

AU - Rocco, B.

AU - Schips, L.

AU - Serni, S.

AU - Serrago, M.

AU - Simeone, C.

AU - Simone, G.

AU - Spadavecchia, R.

AU - Celia, A.

AU - Bove, P.

AU - Zaramella, S.

AU - Crivellaro, S.

AU - Nucciotti, R.

AU - Salvaggio, A.

AU - Frea, B.

AU - Pizzuti, V.

AU - Salsano, L.

AU - Tubaro, A.

PY - 2013/7

Y1 - 2013/7

N2 - Introduction Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. Materials and methods A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. Results Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type ≥IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001). Conclusions In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.

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KW - Bladder cancer

KW - Clavien

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KW - Cystectomy

KW - Urinary diversion

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