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International Journal of Urology (2014) 21, 554–559
doi: 10.1111/iju.12357
Original Article: Clinical Investigation
Comparison of 90-day complications between ileal conduit and neobladder reconstruction after radical cystectomy: A retrospective multi-institutional study in Japan Takashige Abe,1* Norikata Takada,1* Nobuo Shinohara,1 Ryuji Matsumoto,1 Sachiyo Murai,1 Ataru Sazawa,2 Satoru Maruyama,1 Kunihiko Tsuchiya,1 Shino Kanzaki2 and Katsuya Nonomura1 1
Department of Urology, Hokkaido University Graduate School of Medicine, and 2Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
Abbreviations & Acronyms ASA = American Society of Anesthesiologists BMI = body mass index IC = ileal conduit NB = neobladder POD = postoperative day RC = radical cystectomy SSI = surgical site infection UTI = urinary tract infection Correspondence: Takashige Abe M.D., Ph.D., Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo 060-8638, Japan. Email: [email protected] *These two authors contributed equally to this work. Received 15 July 2013; accepted 28 October 2013. Online publication 4 December 2013
Objective: To determine the differences in the type, incidence, and severity of 90-day morbidity after radical cystectomy between two different methods of urinary diversion, ileal conduit and neobladder. Methods: We carried out a retrospective multi-institutional study by reviewing the records of 668 patients treated with open radical cystectomy, and ileal conduit (n = 493) or neobladder substitution (n = 175) between 1997 and 2010. All complications within 90 days after surgery were divided into 11 specific categories as reported by the Memorial-Sloan Kettering Cancer Center, and graded according to the modified Clavien system. Type, incidence and severity of the 90-day morbidity between the two different types of urinary diversions were compared. Results: There was no significant difference in the overall complication rates between the two groups (ileal conduit: 72% [353/493], neobladder: 74% [129/175], P = 0.5909), whereas the neobladder group had fewer major (grade 3 or more) complications (13 vs 20%, respectively, P = 0.0271). The neobladder group had more infectious complications (43 vs 31%, respectively, P = 0.0037), mainly as a result of urinary tract infection, whereas the ileal conduit group had more wound-related complications (24 vs 14%, respectively, P = 0.0068), mainly as a result of surgical site infection. The 90-day mortality rates were 1.1% (2/175) in the neobladder group and 1.6% (8/493) in the ileal conduit group (P = 0.6441). Conclusions: There was no significant difference in the overall complication rates between the two methods, and patients with neobladder had fewer major complications. The neobladder group had more infectious complications, whereas the ileal conduit group had more wound-related complications.
Key words: complication, cystectomy, ileal conduit, morbidity, mortality, neobladder.
Introduction To date, NB substitution has been increasingly selected in high-volume centers, whereas the IC has been a standard method of urinary diversion after RC. Although it is well accepted that RC with subsequent urinary diversion is associated with marked complications, there have been limited studies comparing the perioperative complications between IC and NB.1–4 It is also difficult to compare the different series regarding one type of diversion, because standardized reporting criteria were not used in most of the studies. NB, because of its technical complexity and the longer duration of surgery, could increase perioperative complications. In order to determine the differences in complications after each urinary diversion, according to the standard reporting methods of 11 category groupings established by Shabsigh and Donat et al., we compared the type, incidence and severity of 90-day morbidity related to two different methods of urinary diversion, NB and IC.5
Methods After each institutional review board approval, we reviewed the medical records of 928 patients with muscle invasive or high-grade superficial bladder cancer treated at Hokkaido University Hospital and our 20 affiliated institutions with a standard surgical approach of RC, pelvic lymphadenectomy, and urinary diversion between 1997 and 2010. We collected data on patient characteristics, perioperative outcomes and all complications within 90 days of surgery. Then, 554
© 2013 The Japanese Urological Association
Morbidity after ileal conduit or neobladder
Table 1
Patient characteristics according to type of urinary diversion
Variables Sex (%) Male Female Median age (range) Body mass index, kg/m2 (n = 648) Median (range) Average annual cystectomy volume High (10≤ per year) Moderate (5–10 per year) Low (5≥ per year) No. ASA score (%) I II III-IV Unknown No. prior cardiovascular comorbidity (%) No. prior surgical history (%) No. prior pulmonary comorbidity (%) No. prior cerebrovascular comorbidity (%) No. neoadjuvant chemotherapy (%) Operative time, min (n = 657) Median (range) Estimated blood loss, mL (n = 659) Median (range) No. organ-confined disease, % (n = 657) Postoperative hospital stay, days (n = 649) Median (range)
Ileal conduit (n = 493)
Neobladder (n = 175)
P-value
Total (n = 668)
528 (79%) 140 (21%) 69 (25–89)
364 (74%) 129 (26%) 70 (37–89)
164 (94%) 11 (6%) 63 (25–86)
International Journal of Urology (2014) 21, 554–559
doi: 10.1111/iju.12357
Original Article: Clinical Investigation
Comparison of 90-day complications between ileal conduit and neobladder reconstruction after radical cystectomy: A retrospective multi-institutional study in Japan Takashige Abe,1* Norikata Takada,1* Nobuo Shinohara,1 Ryuji Matsumoto,1 Sachiyo Murai,1 Ataru Sazawa,2 Satoru Maruyama,1 Kunihiko Tsuchiya,1 Shino Kanzaki2 and Katsuya Nonomura1 1
Department of Urology, Hokkaido University Graduate School of Medicine, and 2Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
Abbreviations & Acronyms ASA = American Society of Anesthesiologists BMI = body mass index IC = ileal conduit NB = neobladder POD = postoperative day RC = radical cystectomy SSI = surgical site infection UTI = urinary tract infection Correspondence: Takashige Abe M.D., Ph.D., Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo 060-8638, Japan. Email: [email protected] *These two authors contributed equally to this work. Received 15 July 2013; accepted 28 October 2013. Online publication 4 December 2013
Objective: To determine the differences in the type, incidence, and severity of 90-day morbidity after radical cystectomy between two different methods of urinary diversion, ileal conduit and neobladder. Methods: We carried out a retrospective multi-institutional study by reviewing the records of 668 patients treated with open radical cystectomy, and ileal conduit (n = 493) or neobladder substitution (n = 175) between 1997 and 2010. All complications within 90 days after surgery were divided into 11 specific categories as reported by the Memorial-Sloan Kettering Cancer Center, and graded according to the modified Clavien system. Type, incidence and severity of the 90-day morbidity between the two different types of urinary diversions were compared. Results: There was no significant difference in the overall complication rates between the two groups (ileal conduit: 72% [353/493], neobladder: 74% [129/175], P = 0.5909), whereas the neobladder group had fewer major (grade 3 or more) complications (13 vs 20%, respectively, P = 0.0271). The neobladder group had more infectious complications (43 vs 31%, respectively, P = 0.0037), mainly as a result of urinary tract infection, whereas the ileal conduit group had more wound-related complications (24 vs 14%, respectively, P = 0.0068), mainly as a result of surgical site infection. The 90-day mortality rates were 1.1% (2/175) in the neobladder group and 1.6% (8/493) in the ileal conduit group (P = 0.6441). Conclusions: There was no significant difference in the overall complication rates between the two methods, and patients with neobladder had fewer major complications. The neobladder group had more infectious complications, whereas the ileal conduit group had more wound-related complications.
Key words: complication, cystectomy, ileal conduit, morbidity, mortality, neobladder.
Introduction To date, NB substitution has been increasingly selected in high-volume centers, whereas the IC has been a standard method of urinary diversion after RC. Although it is well accepted that RC with subsequent urinary diversion is associated with marked complications, there have been limited studies comparing the perioperative complications between IC and NB.1–4 It is also difficult to compare the different series regarding one type of diversion, because standardized reporting criteria were not used in most of the studies. NB, because of its technical complexity and the longer duration of surgery, could increase perioperative complications. In order to determine the differences in complications after each urinary diversion, according to the standard reporting methods of 11 category groupings established by Shabsigh and Donat et al., we compared the type, incidence and severity of 90-day morbidity related to two different methods of urinary diversion, NB and IC.5
Methods After each institutional review board approval, we reviewed the medical records of 928 patients with muscle invasive or high-grade superficial bladder cancer treated at Hokkaido University Hospital and our 20 affiliated institutions with a standard surgical approach of RC, pelvic lymphadenectomy, and urinary diversion between 1997 and 2010. We collected data on patient characteristics, perioperative outcomes and all complications within 90 days of surgery. Then, 554
© 2013 The Japanese Urological Association
Morbidity after ileal conduit or neobladder
Table 1
Patient characteristics according to type of urinary diversion
Variables Sex (%) Male Female Median age (range) Body mass index, kg/m2 (n = 648) Median (range) Average annual cystectomy volume High (10≤ per year) Moderate (5–10 per year) Low (5≥ per year) No. ASA score (%) I II III-IV Unknown No. prior cardiovascular comorbidity (%) No. prior surgical history (%) No. prior pulmonary comorbidity (%) No. prior cerebrovascular comorbidity (%) No. neoadjuvant chemotherapy (%) Operative time, min (n = 657) Median (range) Estimated blood loss, mL (n = 659) Median (range) No. organ-confined disease, % (n = 657) Postoperative hospital stay, days (n = 649) Median (range)
Ileal conduit (n = 493)
Neobladder (n = 175)
P-value
Total (n = 668)
528 (79%) 140 (21%) 69 (25–89)
364 (74%) 129 (26%) 70 (37–89)
164 (94%) 11 (6%) 63 (25–86)
![[Complications after ileal conduit: Urinary diversion-associated complications after radical cystectomy].](/assets/img/hold.png)
