PD42-11: Comparison of Comprehensive Complication Index and Clavien-Dindo Classification to Estimate Perioperative Morbidity in Bladder Cancer Patients with Complete Intracorporeal Robot-assisted Radical Cystectomy

Mikolaj Mendrek, Jorn H. Witt, Gronau, Germany, Sergey Sarychev, Frauenfeld, Switzerland, Nikolaos Liakos, Gronau, Germany, Mustapha Addali, Siegen, Germany, Christian Wagner, Theodoros Karagiotis, Andreas Schuette, Gronau, Germany, Armin Soave, Margit Fisch, Hamburg, Germany, Julian Reinisch, Thomas Herrmann, Frauenfeld, Switzerland, Malte W. Vetterlein, Hamburg, Germany, Sami-Ramzi Leyh-Bannurah*, Gronau, Germany

Introduction: Proof-of-concept of cumulative morbidity reporting was recently shown in conventional radicalcystectomy bladder cancer (BCa) patients, but such standards are still eagerly awaited in robot-assisted radical cystectomy (RARC). The aim of this study was to compare and assess suitability of Clavien-Dindo Classification (CDC) vs. Comprehensive Complication Index (CCI®) to capture 30-d complication rates in BCa patients treated with complete intracorporeal RARC and extended pelvic lymph node dissection.

Methods: 30-d complications of BCa patients treated with RARC in two high-volume robotic centers between 2015-2021 were retro- and prospectively captured based on digital charts and medical interview according to a procedure-specific catalog. Each complication was graded by CDC and CCI®. Additionally, we identified and implemented RARC specific items. CDC grade =IIIb and CCI® >33.7 denote severe complications. Multivariable linear regression (MVA) of CCI® was used to identify estimates of higher morbidity, variables included age, body mass index, gender, age-adjusted Charlson comorbidity index, organ-confinement, prior abdominopelvic surgery or radiotherapy, urinary diversion type, percentage of pre- vs. postoperative hemoglobin change and preoperative estimated glomerular filtration rate. The study was performed in accordance with the European Association of Urology (EAU) criteria of standardized reporting.

Results: Of 128 patients, 118 (92%) had overall 367 complications. Of those complications, 179 (49%), 108 (29%), 57 (16%) and 23 (6.3%) were graded as CDC I, II, IIIa and =IIIb, respectively. At patient level, 10 (7.8%), 56 (44%), 43 (34%), and 19 (15%) had no, CDC I-II, IIIa and =IIIb complication, respectively. Overall, rates of reoperation, readmission, and death were 13 (10%), 27 (21%), and 2 (1.6%), respectively. Top three most common 30-d complications were genitourinary (27.5%), miscellaneous (22.3%), and gastrointestinal (20.2%). Utilizing CCI® for cumulative morbidity, 50 patients (39%) yielded a higher percentage of severe complications, which is more than 2.5-fold than aforementioned 15% CDC =IIIb estimate. Specifically, 32/109 (29%) of patients with CDC =IIIa were upgraded to severe CCI >33.7. In MVA, the examined variables did not serve as estimates of higher 30-d morbidity.

Conclusions: Utilizing EAU criteria of standardized reporting and CCI® for cumulative morbidity we showed substantially higher estimates of 30-d morbidity in BCa patients treated with RARC compared to CDC alone. Our study demonstrates the need to adapt these measurements for the robot-assisted approach, complementary to open surgery. This represents the prerequisite to tailor patient counseling with regard to surgical approach, urinary diversion and comparability of results between institutions.

Source of Funding: None