title: Peri-operative morbidity and mortality related to radical cystectomy: a multi-institutional retrospective study in Japan.
abstract: What's known on the subject? and What does the study add? Radical cystectomy remains associated with comparatively high perioperative morbidity and mortality, despite improvements in surgical techniques and perioperative care. At present, most studies on the complications associated with open radical cystectomy were derived from Western academic high-volume centres, and data from Japan and other Asian countries were very limited. Using the modified Clavien grading system and 11 category grouping reported from MSKCC, we observed that 68% of patients experienced at least one complication within 90 days of surgery, and 17% of patients experienced major complications (90-day mortality rate = 2%), which were compatible with reports from Western high-volume centres. As far as we know, our report is the largest one regarding perioperative morbidity and mortality in Asian patients who underwent radical cystectomy.
  
  
  OBJECTIVE
  To determine the type, incidence and severity of 90-day morbidity after radical cystectomy in our institution and our affiliated hospitals in accordance with a standard reporting methodology. At present, most studies on complications associated with open radical cystectomy are derived from Western academic high-volume centres and data from Japan and other Asian countries remain very limited.
  
  
  METHODS
  The study comprised a retrospective multi-institutional study. The records were reviewed of 928 patients who underwent open radical cystectomy between 1997 and 2010. All complications within 90 days of surgery were categorized into 11 specific categories and graded in accordance with the modified Clavien system. Multivariate regression models were used to determine predictors of complications.
  
  
  RESULTS
  At least one complication was observed in 635 (68%) patients and a major (grade 3-5) complication was observed in 156 (17%) patients. The most common complication categories were infectious (30%), gastrointestinal (26%), wound-related (21%) and genitourinary (15%). The 30-day mortality rate was 0.8% and the 90-day mortality rate was 2%. A multivariate regression model showed that previous cardiovascular comorbidity and type of urinary diversion (i.e. ileal conduit or neobladder) were significant factors for any and major complications.
  
  
  CONCLUSIONS
  Surgical complication-related radical cystectomy is significant and both previous cardiovascular comorbidity and the type of urinary diversion were found to be significant factors for any and major complications. The 90-day mortality rate was 2%, which is compatible with reports from Western high-volume centres.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Norikata
authors.initials: N
authors.lastname: Takada
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Maruyama
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shinno
authors.forename: Soshu
authors.initials: S
authors.lastname: Sato
authors.forename: Kimiyoshi
authors.initials: K
authors.lastname: Mitsuhashi
authors.forename: Takuya
authors.initials: T
authors.lastname: Sato
authors.forename: Keiji
authors.initials: K
authors.lastname: Sugishita
authors.forename: Shinji
authors.initials: S
authors.lastname: Kamota
authors.forename: Takanori
authors.initials: T
authors.lastname: Yamashita
authors.forename: Junji
authors.initials: J
authors.lastname: Ishizaki
authors.forename: Takaya
authors.initials: T
authors.lastname: Hioka
authors.forename: Gaku
authors.initials: G
authors.lastname: Mouri
authors.forename: Takenori
authors.initials: T
authors.lastname: Ono
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyajima
authors.forename: Takanori
authors.initials: T
authors.lastname: Sakuta
authors.forename: Tango
authors.initials: T
authors.lastname: Mochizuki
authors.forename: Toshiki
authors.initials: T
authors.lastname: Aoyagi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Katano
authors.forename: Tomoshige
authors.initials: T
authors.lastname: Akino
authors.forename: Kazushi
authors.initials: K
authors.lastname: Hirakawa
authors.forename: Keita
authors.initials: K
authors.lastname: Minami
authors.forename: Akira
authors.initials: A
authors.lastname: Kumagai
authors.forename: Toshimori
authors.initials: T
authors.lastname: Seki
authors.forename: Masaki
authors.initials: M
authors.lastname: Togashi
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D059035:Perioperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000601:surgery