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Complications After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Authors
 Raza S. Johar  ;  Matthew H. Hayn  ;  Andrew P. Stegemann  ;  Kamran Ahmed  ;  Piyush Agarwal  ;  M. Derya Balbay  ;  Ashok Hemal  ;  Adam S. Kibel  ;  Fred Muhletaler  ;  Kenneth Nepple  ;  John G. Pattaras  ;  James O. Peabody  ;  Joan Palou Redorta  ;  Koon-Ho Rha  ;  Lee Richstone  ;  Matthias Saar  ;  Francis Schanne  ;  Douglas S. Scherr  ;  Stefan Siemer  ;  Michael Stökle  ;  Alon Weizer  ;  Peter Wiklund  ;  Timothy Wilson  ;  Michael Woods  ;  Bertrum Yuh  ;  Khurshid A. Guru 
Citation
 EUROPEAN UROLOGY, Vol.64(1) : 52-57, 2013 
Journal Title
 EUROPEAN UROLOGY 
ISSN
 0302-2838 
Issue Date
2013
MeSH
Adult ; Aged ; Aged, 80 and over ; Asia ; Cystectomy/adverse effects* ; Cystectomy/methods ; Cystectomy/mortality ; Europe ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Patient Readmission ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology* ; Postoperative Complications/mortality ; Postoperative Complications/therapy ; Research Design/standards ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Robotics* ; Severity of Illness Index ; Surgery, Computer-Assisted/adverse effects* ; Surgery, Computer-Assisted/mortality ; Time Factors ; Treatment Outcome ; United States ; Urinary Bladder Neoplasms/mortality ; Urinary Bladder Neoplasms/surgery*
Keywords
Robot-assisted ; Robotic ; Robot ; Radical cystectomy ; Complications ; Outcomes
Abstract
BACKGROUND: Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures. OBJECTIVE: To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. DESIGN, SETTING, AND PARTICIPANTS: Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission. RESULTS AND LIMITATIONS: Forty-one percent (n=387) and 48% (n=448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1-2 in 29%, and grade 3-5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study. CONCLUSIONS: Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Full Text
http://www.sciencedirect.com/science/article/pii/S0302283813000134
DOI
10.1016/j.eururo.2013.01.010
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88244
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