ASSESSMENT OF FREQUENCY OF POSTOPERATIVE COMPLICATIONS AND THE POSSIBILITY OF THEIR REDUCTION IN PATIENTS WITH RADICAL CYSTECTOMY: THE SIGHT OF THERAPIST AND SURGEON

The aim of study: to estimate the frequency of postoperative complications and the ways of their reduction in patients after performing «large volume» surgical interventions on the example of radical cystectomy (RCE).

Materials and methods. The study included 73 patients who underwent RCE. All patients were divided into 2 groups: the main group consisted of 29 patients who remained under the active supervision of the therapist throughout the entire hospitalization and underwent preoperative preparation (cardiac examination, correction and prescription of medication). The comparison group comprised 44 patients whose medical history was retrospectively analyzed. Patients of this group did not undergo advanced therapeutic monitoring, both in the preoperative and postoperative period.

Results. In patients of the main group, despite the presence of concomitant pathology in most cases, including cardial pathology, the frequency of postoperative complications was statistically significantly lower than in the comparison group. There were no lethal cases from cardioembolic complications in patients undergoing active therapeutic monitoring. The observation of the therapist throughout the entire hospitalization, as well as the use of the surgical protocol of early activation of the patient, significantly reduced the length of hospitalization, as well as the length of stay in the intensive  care unit.

Conclusion. The introduction of the program of preoperative preparation and therapeutic postoperative monitoring led to a reduction in the incidence of cardiac death and duration of hospitalization in patients undergoing extensive surgical intervention.

1. Witjes J., Lebret T., Compérat E.et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017;71(3):462–75. DOI: 10.1016/j.eururo.2016.06.020. PMID: 27375033.

2. Kaprin A.D., Starinsky V.V., Petrova G.V. Malignant neoplasms in Russia in 2015 (morbidity, mortality). Moscow: Moscow Research Oncology Institute named after P.A. Herzen – branch FSBI «NMRC of radiology» of the Russian Ministry of Health, 2017. 250 р. (In Russ.).

3. Loran O.B., Seregin I.V., Khachatryan A.L., Guspanov R.I. 10-year experience of using direct ureterointestinal anastomoses in intestinal urine derivation after radical and simple cystectomy. Urologiya = Urology 2015;(4):48–51. PMID: 26665765. (In Russ.).

4. Daren- kov S.P., Kotov S.V., Proskokov A.A. et al. The importance of the program «rapid recovery surgery» in the surgical treatment of bladder tumors. Urologiya = Urology 2015;(6):109–15. PMID: 28247690. (In Russ.).

5. Aziz A., May M., Burger M. et al. Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 2014;66(1):156–63. DOI: 10.1016/j.eururo.2013.12.018. PMID: 24388438.

6. Shabsigh A., Korets R., Vora K.C. et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009;55(1):164–74. DOI: 10.1016/j.eururo.2008.07.031. PMID: 18675501.

7. Darenkov S.P., Krivoborodov G.G., Kotov S.V. et al. Postoperative complications of radical cystectomy with ortho- and heterotopic intestinal plasticity (review). Vestnik Rossijskogo gosudarstvennogo medicinskogo universiteta = Vestnik of the Russian State Medical University 2013;(4):49–53. (In Russ.).

8. Harraz A.M., Osman Y., El-Halwagy S. et al. Risk factors of hospital readmission after radical cystectomy and urinary diversion: analysis of a large contemporary series. BJU Int 2015;115(1):94–100. DOI: 10.1111/bju.12830. PMID: 24905239.

9. Stein J., Lieskovsky G., Cote R. et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19(3):666–75. DOI: 10.1200/JCO.2001.19.3.666. PMID: 11157016.

10. Konety B., Allareddy V., Herr H. Complications after radical cystectomy: analysis of population-based data. Urology 2006;68:58–64. DOI: 10.1016/j.urology.2006.01.051. PMID: 16806414.

11. Haden T.D., Prunty M.C., Jones A.B. et al. Comparative Perioperative Outcomes in Septuagenarians and Octogenarians Undergoing Radical Cystectomy for Bladder Cancer-Do Outcomes Differ? Eur Urol Focus 2017;pii: S2405– 4569(17)30197–9. DOI: 10.1016/j.euf.2017.08.005. PMID: 28865996.

12. Novotny V., Hakenberg O.W., Wiessner D. et al. Perioperative complications of radical cystectomy in a contemporary series. Eur Urol 2007;51(2):397–401. DOI: 10.1016/j.eururo.2006.06.014. PMID: 16905242.

13. Fisher M.B., Svatek R.S., Hegarty P.K. et al. Cardiac history and risk of post-cystectomy cardiac complications. Urology 2009;74(5):1085–9. DOI: 10.1016/j.urology.2009.04.103. PMID: 19758689.