Braaksma, Tetske (2020) Postoperative outcomes after two procedures requiring urinary diversion: presenting higher complication rates after Pelvic Exenteration compared to Radical Cystectomy. thesis, Medicine.
Full text available on request.Abstract
Background Pelvic exenteration (PE) and radical cystectomy (RC), treatments for pelvic malignancies and bladder carcinoma respectively, are two different procedures requiring urinary reconstruction. Reducing complications after these procedures remain a significant surgical challenge. In order to gain insight into factors leading to complications and readmission and to identify possible ways to improve patient care, the aim of this study was to compare perioperative outcomes between PE and RC. Methods One hundred eighty-nine patients who were treated with PE (n=85) or RC (n=96) in the UMCG between 2014 and 2019 were included retrospectively. Primary outcome was the overall complication rate, secondary outcomes were ileus, readmission and mortality. Groups were compares using (non)parametric tests in SPSS and factors leading to 30-day readmission in PE were identified using logistic regression. Results PE patients compared to RC patients received significantly more neoadjuvant therapy (67% vs. 10%), underwent longer surgeries (462 vs. 320 min), with higher median blood loss (1500 vs. 500ml) and had longer, more complicated hospital stays (17 vs. 15 days). Overall complications were in PE and RC 94% vs. 76% (p<0.001) respectively, severe complications 31% vs. 22% (p<0.001) and ileus 55% vs. 35% (p=0.007). Interestingly, outcomes were similar in both groups for urologic infections and genitourinary complications, readmission and mortality rates. Patients who received neoadjuvant treatment had a higher major complications rate compared to patients without neoadjuvant treatment, in PE respectively 68% vs. 30% and in RC 66% vs. 30%. Thereby, the risk for PE patients to be readmitted was significantly higher after neoadjuvant treatment (OR: 18.4; 95%CI: 1.6-208; p=0.018). Conclusion Higher complication rates were found in the PE population, supposedly due to the extent of surgery and increased use of neoadjuvant treatment which is the main risk factor for major complications and readmission. Initiation of closer follow-up and optimizing perioperative care in these patients could improve post-operative outcomes.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Altobelli, dr. E. and Leliveld-Kors, dr. A.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 30 Aug 2023 11:25 |
| Last Modified: | 30 Aug 2023 11:25 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3659 |
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