Radical cystectomy in female patients: Does the urinary diversion type affect postoperative complications?

Abstract

752 Background: Data is limited on the possible impact of urinary diversion (UD) type on post cystectomy complications, particularly in women. This study aims to investigate this issue and identify predictors of post-cystectomy complications in female population. Methods: We utilized our prospectively maintained IRB-approved radical cystectomy (RC) database (#HS-01B014) to identify all female patients who underwent RC between 2003 and 2021. Patients were categorized into three groups based on their UD type: ileal conduit (IC), neobladder (NB) and continence cutaneous diversion (CCD). Demographics, baseline characteristics and postoperative complications were compared across the three groups. A multivariate logistic regression analysis was used to assess the predictors of complications at 90 days postoperatively. Results: A total of 531 female patients were included: 263 (49.5%) with IC, 206 (38.8%) with NB, and 62 (11.7%) with CCD. The table outlines the patients' demographics and perioperative characteristics. The overall 30-day complication rates were comparable across groups: 54.9% for NB, 51.6% for CCD, and 61.6% for IC (p = .195). Similarly, 90-day complication rates were also comparable (NB = 65.5%, CCD = 64.5%, IC = 70.3%; p = .456). 90-day complication subgroups including cardiac, pulmonary, gastrointestinal, hematologic, infectious, and neurologic were comparable between different UDs. However, genitourinary complications were significantly higher in CCD (32.3%) compared to IC (13.3%) and NB (14.6%) (p < .001). Multivariate analysis showed that patients with CCD had increased odds of 90-day genitourinary complications compared to NB (OR = 2.83 [95%CI: 1.38, 5.72], p= .001), while preoperative eGFR was protective (OR = 0.987 [95%CI; 0.977, 0.997], p = .010). Conclusions: Our results suggested that UD type has minimal influence on cumulative 30- and 90- day post-cystectomy complications. However, CCD was associated with an increased odds of 90-day genitourinary complications. Demographics and perioperative characteristics of patients stratified by urinary diversion type. Patient characteristics Neobladder(N = 206) Continent Cutaneous Diversion (N =62) Ileal conduit(N = 263) p Age (yrs.) 64.4 ± 9.8 64.2 ± 10.5 73.5 ± 10.4 <.001 Charleson Comorbidity Index 0 80 (38.8%) 25 (40.3%) 41 (15.6%) <.001 1 63 (30.6%) 11 (17.8%) 60 (22.8%) >=2 63 (30.6%) 26 (41.9%) 162 (61.6%) Preoperative eGFR (mL/min) 73.2 ± 24.7 72.3 ± 32.0 63.8 ± 29.0 <.001 Surgical Approach Open 196 (95.1%) 60 (96.8%) 177 (67.3%) <.001 Robotic assisted 10 (4.9%) 2 (3.2%) 86 (32.7%) Pathological Staging OC (< (y)pT2; pN0) 166 (80.6%) 44 (71.0%) 168 (63.9%) .002 EV (> (y)pT2; pN0) 26 (12.6%) 9 (14.5%) 62 (23.6%) LN+ (pN+) 14 (6.8%) 9 (14.5%) 33 (12.5%)