Factors Affecting Evisceration Following Open Radical Cystectomy

Yıl 2022, Cilt: 4 Sayı: 3, 108 - 112, 10.11.2022

Cem Kezer , Mehmet Fatih Akbulut , Ömer Sarılar , Ufuk Çağlar , Mücahit Gelmiş , Faruk Özgör

https://doi.org/10.38175/phnx.1121645

Öz

Introduction: To clarify predictive factors for evisceration after open radical cystectomy (ORC).
Methods: Charts for patients who underwent ORC between 2017 and 2021 were reviewed retrospectively. Patient demographic characteristics and operative outcomes were recorded. Patients who underwent ORC were divided into two groups as patients who developed evisceration (Group 1) and patients who did not develop evisceration (Group 2). The groups were compared according to patient preoperative characteristics, intraoperative parameters and postoperative outcomes.
Results: Total, 164 patients met study inclusion criteria, and 24 patients with evisceration and 140 patients without evisceration were enrolled into Group 1 and Group 2, respectively. In contrast, the presence of diabetes mellitus was significantly higher in eviscerated patients (25.0% and 5.7% p= 0.002), and eviscerated patients had significantly higher BMI (28.8 kg/m2 and 24.9 kg/m2, p= 0.001). Also, non-eviscerated patients had significantly higher preoperative albumin level (p= 0.001). Moreover, the operation time was significantly longer in patients with evisceration (332.5 min and 268.3 min, p= 0.001) and lymph node positivity was significantly higher in patients with evisceration (50.0% and 26.4%, p= 0.020). Multivariate regression analysis revealed that higher BMI, lower preoperative albumin level, and longer operation time were significantly associated with evisceration after ORC. Also, the presence of diabetes mellitus increased the risk of evisceration seven-fold following ORC.
Conclusion: Present study showed for the first time that higher BMI, lower preoperative albumin level, longer operation time and presence of diabetes mellitus were predictive factors for evisceration following ORC.

Anahtar Kelimeler

bladder cancer, complication, evisceration, radical cystectomy

Teşekkür

Dear Editor; Radical cystectomy (RC), is accepted as a standard surgical method for patients with non-metastatic muscle invasive bladder cancer and patients with non-muscle invasive bladder cancer which cannot be treated with endoscopic methods. Although RC can be performed as laparoscopic and robot-assisted surgery, open radical cystectomy (ORC) is widely performed due to the extended learning curve for laparoscopic RC, the high cost of robotic surgery and the difficulty of accessing the robotic system. Despite the improvements in preoperative assessment methods and surgical techniques, ORC remains one of the most complex surgeries in urology practice. Previous studies showed that ORC involves some potential complications including acute renal failure, haemorrhage, lymphocele, wound infection and evisceration. Although previous reports stated that evisceration was a serious complication following ORC, no study has investigated the risk factors for evisceration after ORC. In the present study, we aimed to clarify predictive factors for evisceration after ORC. Yours sincerely, Faruk OZGOR, Assoc PROF

Açık Radikal Sistektomi Sonrası Eviserasyona Etki Eden Faktörler

Öz

Giriş: Açık radikal sistektomiden (ORC) sonra eviserasyon için prediktif faktörleri netleştirmek.
Yöntemler: 2017-2021 yılları arasında ORC uygulanan hastaların çizelgeleri geriye dönük olarak incelendi. Hastaların demografik özellikleri ve ameliyat sonuçları kaydedildi. ORC uygulanan hastalar eviserasyon gelişen hastalar (Grup 1) ve eviserasyon gelişmeyen hastalar (Grup 2) olarak iki gruba ayrıldı. Gruplar hasta preoperatif özellikleri, intraoperatif parametreler ve postoperatif sonuçlara göre karşılaştırıldı.
Bulgular: Toplam 164 hasta çalışmaya dahil edilme kriterlerini karşıladı ve eviserasyonlu 24 hasta ve eviserasyonsuz 140 hasta sırasıyla Grup 1 ve Grup 2'ye alındı. Buna karşılık, eviserasyon olan hastalarda diabetes mellitus varlığı anlamlı olarak daha yüksekti (%25.0 ve %5.7 p= 0.002) ve yine bu hastalarda VKİ anlamlı olarak daha yüksekti (28.8 kg/m2 ve 24.9 kg/m2, p= 0.001). Ayrıca evisere olmayan hastalarda preoperatif albümin düzeyi anlamlı olarak daha yüksekti (p= 0.001). Ayrıca eviserasyonlu hastalarda ameliyat süresi anlamlı olarak daha uzundu (332.5 dk ve 268.3 dk, p= 0.001) ve eviserasyonlu hastalarda lenf nodu pozitifliği anlamlı olarak daha yüksekti (%50.0 ve %26.4, p= 0.020). Çok değişkenli regresyon analizi, daha yüksek BMI, daha düşük preoperatif albümin seviyesi ve daha uzun operasyon süresinin ORC sonrası eviserasyon ile anlamlı şekilde ilişkili olduğunu ortaya koydu. Ayrıca, diabetes mellitus varlığı, ORC'yi takiben eviserasyon riskini yedi kat arttırdı.
Sonuç: Bu çalışma ilk kez daha yüksek BMI, daha düşük preoperatif albümin seviyesi, daha uzun operasyon süresi ve diabetes mellitus varlığının ORC sonrası eviserasyon için prediktif faktörler olduğunu göstermiştir.

Anahtar Kelimeler

mesane kanseri, komplikasyon, eviserasyon, radikal sistektomi

Kaynakça

• Ziegelmueller BK, Jokisch JF, Buchner A, Grimm T, Kretschmer A, Schulz GB, et al. Long-Term Follow-Up and Oncological Outcome of Patients Undergoing Radical Cystectomy for Bladder Cancer following an Enhanced Recovery after Surgery (ERAS) Protocol: Results of a Large Randomized, Prospective, Single-Center Study. Urol Int. 2020;104:55-61.
• Khan MS, Challacombe B, Elhage O, Rimington P, Coker B, Murphy D, et al. A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy. Int J Clin Pract. 2012:66:656-662.
• Zattoni F, Palumbo V, Giannarini G, Crestani A, Kungulli A, Novara G, et al. Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer. Urol Int. 2018;100:13-17.
• Schiavina R, Borghesi M, Guidi M, Vagnoni V, Zukerman Z, Pultrone C, et al. Perioperative complications and mortality after radical cystectomy when using a standardized reporting methodology. Clin Genitourin Cancer. 2013;11:189-197.
• Cantiello F, Cicione A, Autorino R, De Nunzio C, Salonia A, Briganti A, et al. Metabolic syndrome, obesity, and radical cystectomy complications: a clavien classification system-based analysis. Clin Genitourin Cancer. 2014;12:384-393.
• Greenhalgh David G. Wound healing and diabetes mellitus. Clinics in Plastic Surgery. 2003;30: 37-45.
• Mahey R, Ghetla S, Rajpurohit J, Desai D, Suryawanshi S. A prospective study of risk factors for abdominal wound dehiscence. International Surgery Journal. 2016;4:24-28.
• Pavlidis TE, Galatianos IN, Papaziogas BT, Lazaridis CN, Atmatzidis KS, Makris JG, et al. Complete dehiscence of the abdominal wound and incriminating factors. Eur J Surg. 2001;167:351-354.
• Spiliotis J, Tsiveriotis K, Datsis AD, Vaxevanidou A, Zacharis G, Giafis K, et al. Wound dehiscence: is still a problem in the 21th century: a retrospective study. World J Emerg Surg. 2009:3;4-12.
• Riou JP, Cohen JR, Johnson H Jr. Factors influencing wound dehiscence. Am J Surg. 1992;163(3):324-330.
• Kenig J, Richter P, Lasek A, Zbierska K, Zurawska S. The efficacy of risk scores for predicting abdominal wound dehiscence: a case-controlled validation study. BMC Surg. 2014:14;65-72.
• Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23:265-270.
• Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26:499-502.