PATIENTS WITH PERIOPERATIVE COMPLICATIONS PRESENTED AN HIGHER RISK OF CANCER SPECIFIC MORTALITY AFTER RADICAL CYSTECTOMY: A TWO YEAR MULTICENTRE ITALIAN REAL-LIFE ANALYSIS

Aim of the study Recently the modified Clavien classification system (CCS) has been proposed as the standard method in grading perioperative complications of radical cistectomy in patients with bladder cancer. Aim of our study was to evaluate the impact of perioperative complications graded with the CCS and the oncological outcome of patients treated with radical cystectomy. Materials and methods A consecutive series of patients with primitive or recurrent bladder cancer treated with radical cistectomy from April 2011 to March 2012 at 19 centres in Italy were evaluated for complications occurring up to the end of the first postoperative month. All complications were prospectively recorded and classified according to the modified CCS. Patients were re-evaluated every six months for two years with a thoracic and abdomen TC scan to analyze the oncological outcome. Results were presented as complication rates per grade and overall cancer specific mortality. Chi-square and Kruskal Wallis tests and binary logistic regression analysis were used for statistical analysis. Results 348 patients were prospectively enrolled. Mean age was 69 ±9.4 years; mean BMI was 28.5 ± 6.3 Kg/m2. Mean follow-up was 18 ± 7 months. All patients underwent radical cistectomy. Urinary diversion consisted in orthotopic neobladder in 91 patients (26%), ileal conduit in 139 patients (40%) and ureterocutaneostomy in 118 patients (34%%). 179 patients presented an advanged pathological stage (≥pT3a) and 169 a localized disease . Discussion In our experience, using this CCS tool, radical cistectomy is associated with a significant morbidity and a significant cancer specific mortality in patients with an advanced pathological stage and in patients with moderate/severe complications occurred during the procedure. Conclusions The modified CCS represents a practical and easily applicable tool that may help urologists to classify the complications of radical cistectomy and to predict the oncological outcome.