Metabolic syndrome, obesity, and radical cystectomy complications: a clavien classification system-based analysis.
BACKGROUND
The objective of this study was to evaluate the effect of MetS and its components on the early complications observed in patients treated with RC and urinary diversion.


METHODS
We retrospectively analyzed 346 patients with bladder cancer undergoing RC with standard lymphadenectomy, according to the procedure suggested by the International Consultation on Bladder Cancer, and urinary diversion. All early complications within 90 days of surgery were recorded and collected according to the 10 Martin criteria and classified according to the established 5 grades of the modified Clavien classification system (CCS). MetS was defined according to the National Cholesterol Educational Program's Third Adult Treatment Panel. A binary logistic regression analysis was used to analyze MetS and, separately, its single components, as possible independent risk factors for high-grade complications.


RESULTS
A total of 323 complications occurred in 231 of 346 patients (66.8%). The rates for low-grade (CCS I-II) and high-grade complications (CCS III-V), and mortality within 90 days (CCS V), were 80.8% (261 of 323), 19.2% (62 of 323), and 1.7% (6 of 346), respectively. At univariate analysis, MetS patients showed a higher rate of high-grade complications compared with patients without MetS (P < .001). At binary logistic regression analysis, MetS (OR, 1.3; P = .010), waist circumference (OR, 1.9; P = .022) and, only in single model, urinary diversion (OR, 1.3; P = .024) were independent risk factors for high-grade complications.


CONCLUSIONS
RC is a major surgical procedure with a significant early complications rate, nevertheless, most are low-grade complications. MetS and, separately, waist circumference are associated with high-grade complications.
Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy. Electronic address: cantiello@unicz.it.
Francesco
F
Cantiello
Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Antonio
A
Cicione
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Riccardo
R
Autorino
Department of Urology, La Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
Cosimo
C
De Nunzio
Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy; Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.
Andrea
A
Salonia
Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy; Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.
Alberto
A
Briganti
Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Antonio
A
Aliberti
Department of Urology, National Cancer Institute of Naples, Naples, Italy.
Sisto
S
Perdonà
Department of Urology, La Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
Andrea
A
Tubaro
Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Rocco
R
Damiano
D000368:Aged; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000401:mortality
Bladder cancer; Clavien system; Early complication; Metabolic syndrome; Urinary diversion