title: Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort.
abstract: BACKGROUND
  Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer.
  
  
  METHODS
  A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis.
  
  
  RESULTS
  
  
  
  CONCLUSIONS
  467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type ≥IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001).
  
  
  CONCLUSIONS
  In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.
authors.affiliation: University "La Sapienza", Ospedale Sant'Andrea, Dept. of Urology, Roma, Italy. cosimodenunzio@virgilio.it
authors.forename: C
authors.initials: C
authors.lastname: De Nunzio
authors.forename: L
authors.initials: L
authors.lastname: Cindolo
authors.forename: C
authors.initials: C
authors.lastname: Leonardo
authors.forename: A
authors.initials: A
authors.lastname: Antonelli
authors.forename: C
authors.initials: C
authors.lastname: Ceruti
authors.forename: G
authors.initials: G
authors.lastname: Franco
authors.forename: M
authors.initials: M
authors.lastname: Falsaperla
authors.forename: M
authors.initials: M
authors.lastname: Gallucci
authors.forename: M
authors.initials: M
authors.lastname: Alvarez-Maestro
authors.forename: A
authors.initials: A
authors.lastname: Minervini
authors.forename: V
authors.initials: V
authors.lastname: Pagliarulo
authors.forename: P
authors.initials: P
authors.lastname: Parma
authors.forename: S
authors.initials: S
authors.lastname: Perdonà
authors.forename: A
authors.initials: A
authors.lastname: Porreca
authors.forename: B
authors.initials: B
authors.lastname: Rocco
authors.forename: L
authors.initials: L
authors.lastname: Schips
authors.forename: S
authors.initials: S
authors.lastname: Serni
authors.forename: M
authors.initials: M
authors.lastname: Serrago
authors.forename: C
authors.initials: C
authors.lastname: Simeone
authors.forename: G
authors.initials: G
authors.lastname: Simone
authors.forename: R
authors.initials: R
authors.lastname: Spadavecchia
authors.forename: A
authors.initials: A
authors.lastname: Celia
authors.forename: P
authors.initials: P
authors.lastname: Bove
authors.forename: S
authors.initials: S
authors.lastname: Zaramella
authors.forename: S
authors.initials: S
authors.lastname: Crivellaro
authors.forename: R
authors.initials: R
authors.lastname: Nucciotti
authors.forename: A
authors.initials: A
authors.lastname: Salvaggio
authors.forename: B
authors.initials: B
authors.lastname: Frea
authors.forename: V
authors.initials: V
authors.lastname: Pizzuti
authors.forename: L
authors.initials: L
authors.lastname: Salsano
authors.forename: A
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003558:Cystoscopy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000145:classification* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014519:Ureterostomy / Q000009:adverse effects / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects