title: The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology.
abstract: OBJECTIVE
  To analyze postoperative complications after laparoscopic radical cystectomy (LRC) and evaluate its risk factors in a large prospective cohort built by the ESUT across European centers involved in minimally invasive urology in the last decade.
  
  
  METHODS
  Patients were prospectively enrolled, and data were retrospectively analyzed. Only oncologic cases were included. There were no formal contraindications for LRC: Also patients with locally advanced tumors (pT4a), serious comorbidities, and previous major abdominal surgery were enrolled. All procedures were performed via a standard laparoscopic approach, with no robotic assistance. Early and late postoperative complications were graded according to the modified Clavien-Dindo classification. Multivariate logistic regression was performed to explore possible risk factors for developing complications.
  
  
  RESULTS
  A total of 548 patients were available for final analysis, of which 258 (47%) experienced early complications during the first 90 days after LRC. Infectious, gastrointestinal, and genitourinary were, respectively, the most frequent systems involved. Postoperative ileus occurred in 51/548 (9.3%) patients. A total of 65/548 (12%) patients underwent surgical re-operation, and 10/548 (2%) patients died in the early postoperative period. Increased BMI (p = 0.024), blood loss (p = 0.021), and neoadjuvant treatment (p = 0.016) were significantly associated with a greater overall risk of experiencing complications on multivariate logistic regression. Long-term complications were documented in 64/548 (12%), and involved mainly stenosis of the uretero-ileal anastomosis or incisional hernias.
  
  
  CONCLUSIONS
  In this multicenter, prospective, large database, LRC appears to be a safe but morbid procedure. Standardized complication reporting should be encouraged to evaluate objectively a surgical procedure and permit comparison across studies.
authors.affiliation: Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium. albisinni.simone@gmail.com.|Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 121, Brussels, Belgium. albisinni.simone@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Albisinni
authors.affiliation: Department of Urology, Clinique Saint Augustin, Bordeaux, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Oderda
authors.affiliation: Department of Urology, Maxima Medisch Centrum, Eindhoven, The Netherlands.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fossion
authors.affiliation: Department of Urology, Ospedale Luigi Sacco, Milan, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Varca
authors.affiliation: Department of Urology, SLK Kliniken, Heilbronn, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
authors.affiliation: Department of Urology, Institut Montsouris, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.affiliation: Department of Urology, Jagiellonian University, Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chlosta
authors.affiliation: Department of Urology, CHU Henri Mondor, Creteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: De la Taille
authors.affiliation: Department of Urology, Ospedale Luigi Sacco, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Gaboardi
authors.affiliation: Department of Urology, Clinique Saint Augustin, Bordeaux, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Piechaud
authors.affiliation: Department of Urology, East Sussex Healthcare NHS Trust, Eastbourne, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Rimington
authors.affiliation: Department of Urology, CHU Henri Mondor, Creteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Department of Urology, Institut Montsouris, Paris, France.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.affiliation: Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 121, Brussels, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Van Velthoven
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012955:Societies, Medical; D016896:Treatment Outcome; D014572:Urology
keywords: Clavien; Complications; Cystectomy; Laparoscopy