末期腎衰竭病人罹患泌尿道上皮癌接受一次性腎臟、輸尿管及膀胱全切除手術的發症及死亡率
黃雲慶、張殷綸、林健輝、何東儒、陳志碩
財團法人嘉義長庚紀念醫院 外科部 泌尿科
Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-stage Complete Urinary Tract Extirpation
Yun-Ching Huang, Yin-Lun Chang, Jian-Hui Lin, Dong-Ru Ho, Chih-Shou Chen
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
Purpose: Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and risk of major postoperative complications has not been systematically investigated. The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE.
Methods: Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher’s exact with x2 and two-tailed t tests were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications.
Results: In this population 53 (65.4%) patients had Clavien grade 0-2 complications (“no major complications”), whereas 28 (34.6%) patients had Clavien grade 3-5 complications (“major complications”). Compared with the major complications group, patients in the no-major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher pre-operative serum albumin, and shorter duration of hospitalization, (p < 0.05 for all). Major complications were more common in low volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (OR: 6.25; 95% CI: 1.42-27.47; p = 0.015) and surgery by a provider who performed 3 or fewer cases during the study interval (OR: 13.4; 95% CI: 2.20-80.89; p = 0.005) were independent predictors for major complications.
Conclusion: High CCI should alert providers to increased probability of major complications and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.