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Complications after radical cystectomy according to the Clavien system and their impact on survival - a single center experience.
Marc D. Manganiello, M.D., John A. Libertino, M.D., Andrea Sorcini, M.D., Karim J. Hamawy, M.D., Ali Moinzadeh, M.D., David Canes, M.D., Jason R. Gee, M.D..
Lahey Clinic Medical Center, Burlington, MA, USA.

BACKGROUND: Radical cystectomy is the standard treatment for organ-confined muscle-invasive urothelial carcinoma of the bladder and is known to carry significant morbidity. The purpose of this study is to validate a standardized classification of post-operative complications of patients undergoing radical cystectomy and their relationship to cumulative survival, type of urinary diversion, smoking and cancer stage.
METHODS: Post-operative complications of 968 patients with bladder cancer who underwent radical cystectomy at the Lahey Clinic were recorded in our database with prospective followup. Post-operative complications were graded as 0 (none), 1 (oral medication), 2 (systemic therapy), 3 (surgical or procedural intervention), 4 (major morbidity) and 5 (fatal) according to the Clavien system of classification based on the most severe complication. Kaplan-Meier survival analysis was utilized for comparison.
RESULTS: Of 968 consecutive patients with bladder cancer who underwent radical cystectomy a total of 591 (61%) complications were reported. Perioperative mortality was calculated at 1.3% (13/968). Average followup was 30 months following cystectomy with a median followup of 19 months. A total of 116 (12%) patients had moderate to severe (Clavien 3-5) complications. Overall survival of patients with relatively minor complications (Clavien 0-1 or 0-2) as compared to patients with more severe complications was significantly higher (p<.001, log rank). In the subset of 653 (67%) patients who remained disease-free until last followup, the comparison of survival between patients with lower and higher Clavien scores was again found to be significant (p<.001). No significant differences in Clavien complication scores were noted in patients when compared on the basis of urinary diversion type (continent diversion vs conduit), smoking status, or cancer stage.
CONCLUSIONS: Our findings validate the utility of the Clavien scoring system and demonstrate a highly significant trend in predicting overall and disease-free survival following radical cystectomy for patients with bladder cancer. The use of continent urinary diversion does not adversely impact the risk of complications in our experience.


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