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. 2022 Feb 14;12(2):281.
doi: 10.3390/jpm12020281.

A Personalized Approach to Radical Cystectomy Can Decrease Its Complication Rates

Przemyslaw Adamczyk  1 , Pawel Poblocki  1 , Cyprian Michalik  2 , Mateusz Kadlubowski  1 , Jan Adamowicz  3 , Witold Mikolajczak  1 , Tomasz Drewa  1   3 , Kajetan Juszczak  3
Affiliations

A Personalized Approach to Radical Cystectomy Can Decrease Its Complication Rates

Przemyslaw Adamczyk et al. J Pers Med. .

Abstract

The aim of this study was to assess the influence of a patient's general status on perioperative morbidity and mortality after radical cystectomy, and to assess which of the used scales is best for the prediction of major complications. The data of 331 patients with muscle-invasive bladder cancer, who underwent radical cystectomy, were analyzed. The general status was assessed according to the American Society of Anesthesiologists (ASA), Charlson Comorbidity Index (CCI), Eastern Cooperative Oncology Group (ECOG), and Geriatric-8 (G-8) scales. Complications were classified according to the Clavien-Dindo classification system. In a group of patients with the highest complication rate according to the Clavien-Dindo scale, (i) statistically more patients rated high according to the ASA and ECOG scales, (ii) patients had significantly higher CCI scores (minor complications (I-II), and (iii) there were significantly more patients rated as frail with G8-predominantly those with 11 points or fewer in the scale. A patient's general status should be assessed before the start of therapy because patients with a high risk of death or serious complications (evaluated with any rating scale) should be offered conservative treatment. None of the scales can describe the risk of cystectomy, because the percentage of patients with major complications among those who achieved worse score results on any scale was not significantly different from the percentage of patients with major complications in the general group.

Keywords: ASA scale; CCI scale; Clavien–Dindo scale; ECOG scale; G-8; bladder cancer; complications; radical cystectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Chance of 10-year survival in the studied group according to the CCI scale. Number of cases: Number of patients with the indicated chance of 10-year survival. Chance expressed as a percentage.
Figure 2
Figure 2
Complications in the study group according to Clavien–Dindo grades (1,2—minor complications, 3,4—major complications) depending on the urinary derivation.
Figure 3
Figure 3
Relationship between ASA-assessed preoperative status and complications (number and percentage of patients).
Figure 4
Figure 4
Relationship between ECOG-assessed preoperative status and complications (number and percentage of patients).
Figure 5
Figure 5
Relationship between CCI-assessed preoperative status and complications (number and percentage of patients).
Figure 6
Figure 6
Relationship between G8-assessed preoperative status and complications (number and percentage of patients).
See this image and copyright information in PMC

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