Open radical cystectomy (ORC) remains the gold standard for the treatment of muscle-invasive and high-risk non-muscle invasive bladder cancer unsuitable for bladder preservation techniques. Despite improvements in operative technique and perioperative care, it continues to be associated with significant complications. We analyzed our series of prospectively collected data of patients that underwent ORC at a tertiary referral academic center and evaluated early and late postoperative complications and mortality. The records of 391 ORCs with ileal diversion performed at our institution between January 2008 and July 2018 for non-metastatic transitional bladder carcinoma and other distinct pathological types were analyzed. Perioperative mortality was determined and 30-day and 90-day complications were reported according to the Martin Criteria and the European Association of Urology and graded according to the five-grade Clavien-Dindo classification. Univariate and multivariate analyses were used to evaluate predictors of complications and mortality. Gastrointestinal and infectious complications represented 41% and 43% of the total complications observed at 30 and 90 days from the surgery, respectively. The strongest predictor of infectious complications was the choice of ileal neobladder as the urinary diversion (p ≤ 0.0001). Diabetes was a predictor of the overall, major and major infectious complications (p < 0.05). The 30-day mortality rate was 1% while the 90-day mortality rate was 1.5%. Age ≥ 75 was the single predictor of mortality at both 30-days (p-value 0.003) and 90-days (p-value 0.01) in univariate and multivariate analyses. ORC is a morbid procedure, associated with a high mortality rate. Elderly patients should have proper counseling before indication of this procedure. Gastrointestinal and infectious complications represent the most common and serious complications, and the study of their predictors is of the utmost importance.

中文翻译：

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开放式根治性膀胱切除术和回肠改道后的发病率和死亡率 - 10 年的经验和在单一三级中心的综合评估。

开放性根治性膀胱切除术 (ORC) 仍然是治疗不适合膀胱保留技术的肌肉浸润性和高风险非肌肉浸润性膀胱癌的金标准。尽管手术技术和围手术期护理有所改进，但它仍然与严重的并发症有关。我们分析了我们在三级转诊学术中心接受 ORC 的患者的一系列前瞻性收集数据，并评估了早期和晚期术后并发症和死亡率。分析了 2008 年 1 月至 2018 年 7 月在我们机构进行的 391 例非转移性移行膀胱癌和其他不同病理类型的回肠改道 ORC 的记录。根据 Martin 标准和欧洲泌尿外科协会确定围手术期死亡率并报告 30 天和 90 天并发症，并根据五级 Clavien-Dindo 分类进行分级。使用单变量和多变量分析来评估并发症和死亡率的预测因素。胃肠道和感染并发症分别占手术后 30 天和 90 天观察到的总并发症的 41% 和 43%。感染并发症的最强预测因子是选择回肠新膀胱作为尿流改道（p ≤ 0.0001）。糖尿病是总体、主要和主要感染并发症的预测因子（p < 0.05）。30天死亡率为1%，而90天死亡率为1.5%。在单变量和多变量分析中，年龄≥75 岁是 30 天（p 值 0.003）和 90 天（p 值 0.01）死亡率的单一预测因子​​。ORC 是一种病态的手术，死亡率很高。老年患者在接受此程序之前应进行适当的咨询。胃肠道和感染性并发症是最常见和最严重的并发症，对其预测因素的研究至关重要。