Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium

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

doi:10.1016/j.eururo.2013.01.010

Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium

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 StökleAlon Weizer, Peter Wiklund, Timothy Wilson, Michael Woods, Bertrum Yuh, Khurshid A Guru

Roswell Park Cancer Institute

Research output: Contribution to journal › Article › peer-review

183 Citations (Scopus)

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.

Original language	English
Pages (from-to)	52-7
Number of pages	6
Journal	European Urology
Volume	64
Issue number	1
DOIs	https://doi.org/10.1016/j.eururo.2013.01.010
Publication status	Published - Jul 2013

Keywords

Adult
Aged
Aged, 80 and over
Asia
Cystectomy/adverse effects
Europe
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Readmission
Postoperative Complications/diagnosis
Research Design/standards
Retrospective Studies
Risk Assessment
Risk Factors
Robotics
Severity of Illness Index
Surgery, Computer-Assisted/adverse effects
Time Factors
Treatment Outcome
United States
Urinary Bladder Neoplasms/mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.eururo.2013.01.010

Cite this

Johar, R. S., Hayn, M. H., Stegemann, A. P., Ahmed, K., Agarwal, P., Balbay, M. D., Hemal, A., Kibel, A. S., Muhletaler, F., Nepple, K., Pattaras, J. G., Peabody, J. O., Palou Redorta, J., Rha, K.-H., Richstone, L., Saar, M., Schanne, F., Scherr, D. S., Siemer, S., ... Guru, K. A. (2013). Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. European Urology, 64(1), 52-7. https://doi.org/10.1016/j.eururo.2013.01.010

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title = "Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium",

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.",

keywords = "Adult, Aged, Aged, 80 and over, Asia, Cystectomy/adverse effects, Europe, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Patient Readmission, Postoperative Complications/diagnosis, Research Design/standards, Retrospective Studies, Risk Assessment, Risk Factors, Robotics, Severity of Illness Index, Surgery, Computer-Assisted/adverse effects, Time Factors, Treatment Outcome, United States, Urinary Bladder Neoplasms/mortality",

author = "Johar, {Raza S} and Hayn, {Matthew H} and Stegemann, {Andrew P} and Kamran Ahmed and Piyush Agarwal and Balbay, {M Derya} and Ashok Hemal and Kibel, {Adam S} and Fred Muhletaler and Kenneth Nepple and Pattaras, {John G} and Peabody, {James O} and {Palou Redorta}, Joan and Koon-Ho Rha and Lee Richstone and Matthias Saar and Francis Schanne and Scherr, {Douglas S} and Stefan Siemer and Michael St{\"o}kle and Alon Weizer and Peter Wiklund and Timothy Wilson and Michael Woods and Bertrum Yuh and Guru, {Khurshid A}",

year = "2013",

month = jul,

doi = "10.1016/j.eururo.2013.01.010",

language = "English",

volume = "64",

pages = "52--7",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier",

number = "1",

}

Johar, RS, Hayn, MH, Stegemann, AP, Ahmed, K, Agarwal, P, Balbay, MD, Hemal, A, Kibel, AS, Muhletaler, F, Nepple, K, Pattaras, JG, Peabody, JO, Palou Redorta, J, Rha, K-H, Richstone, L, Saar, M, Schanne, F, Scherr, DS, Siemer, S, Stökle, M, Weizer, A, Wiklund, P, Wilson, T, Woods, M, Yuh, B & Guru, KA 2013, 'Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium', European Urology, vol. 64, no. 1, pp. 52-7. https://doi.org/10.1016/j.eururo.2013.01.010

TY - JOUR

T1 - Complications after robot-assisted radical cystectomy

T2 - results from the International Robotic Cystectomy Consortium

AU - Johar, Raza S

AU - Hayn, Matthew H

AU - Stegemann, Andrew P

AU - Ahmed, Kamran

AU - Agarwal, Piyush

AU - Balbay, M Derya

AU - Hemal, Ashok

AU - Kibel, Adam S

AU - Muhletaler, Fred

AU - Nepple, Kenneth

AU - Pattaras, John G

AU - Peabody, James O

AU - Palou Redorta, Joan

AU - Rha, Koon-Ho

AU - Richstone, Lee

AU - Saar, Matthias

AU - Schanne, Francis

AU - Scherr, Douglas S

AU - Siemer, Stefan

AU - Stökle, Michael

AU - Weizer, Alon

AU - Wiklund, Peter

AU - Wilson, Timothy

AU - Woods, Michael

AU - Yuh, Bertrum

AU - Guru, Khurshid A

PY - 2013/7

Y1 - 2013/7

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Asia

KW - Cystectomy/adverse effects

KW - Europe

KW - Female

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Odds Ratio

KW - Patient Readmission

KW - Postoperative Complications/diagnosis

KW - Research Design/standards

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Robotics

KW - Severity of Illness Index

KW - Surgery, Computer-Assisted/adverse effects

KW - Time Factors

KW - Treatment Outcome

KW - United States

KW - Urinary Bladder Neoplasms/mortality

U2 - 10.1016/j.eururo.2013.01.010

DO - 10.1016/j.eururo.2013.01.010

M3 - Article

C2 - 23380164

SN - 0302-2838

VL - 64

SP - 52

EP - 57

JO - European Urology

JF - European Urology

IS - 1

ER -

Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium

Abstract

Keywords

UN SDGs

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