Correlation analysis of preoperative renal insufficiency with major complications in patients who received a radical cystectomy and pelvic lymph node dissection: results of a retrospective observational analysis from a single center

Haixin Wang; Haiwen Huang; Han Hao; Zhijun Xi

doi:10.3389/fonc.2024.1453346

Correlation analysis of preoperative renal insufficiency with major complications in patients who received a radical cystectomy and pelvic lymph node dissection: results of a retrospective observational analysis from a single center

Front Oncol. 2024 Nov 22:14:1453346. doi: 10.3389/fonc.2024.1453346. eCollection 2024.

Authors

Haixin Wang^#^{1

2

3

4}, Haiwen Huang^#⁵, Han Hao^{1

2

3}, Zhijun Xi^{1

2

3}

Affiliations

¹ Department of Urology, Peking University First Hospital, Beijing, China.
² Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
³ National Research Center for Genitourinary Oncology, Beijing, China.
⁴ Department of Urology, Yankuang New Journey General Hospital, Zoucheng, Shandong, China.
⁵ Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China.

^# Contributed equally.

Abstract

Objective: The aim of this study was to explore the factors affecting the major complications and the impacts of preoperative renal function on the incidence of complications in radical cystectomy procedures.

Methods: A retrospective review of 705 patients who received radical cystectomy between 2006 and 2021 was conducted. The 90-day complications of patients after a radical cystectomy were reported and the Clavien-Dindo classification (CDC) was used for grading complications. The clinical characteristics and preoperative outcomes were compared among patients with different preoperative renal functions. A logistic regression analysis of all patients was used to identify the risk factors associated with the major complications. Spearman's correlation analysis was used to examine the relationship between the classification of renal insufficiency and the CDC. In order to reduce the selection bias, one-to-one propensity score matching was performed, and the comparison of complications after matching was carried out for the sensitivity analysis.

Results: Within 90 days post-surgery, 71% of patients experienced complications, with 4.8% of them being major. Patients with preoperative renal insufficiency had a higher CDC and had a higher rate of major complications (16.7% vs 3.7%, p < 0.001). There was a linear relationship between preoperative serum creatinine and complications. Spearman's correlation analysis showed a slightly positive correlation between the classification of renal insufficiency and the CDC (r=0.094, p = 0.013). Preoperative renal insufficiency was a risk factor for major complications (OR = 6.805 [95%CI: 2.706-17.112]; p < 0.001). After matching, the patients in the preoperative renal insufficiency group had a higher CDC and a higher incidence of major complications (16.9% vs 1.7%, p = 0.004).

Conclusions: In our cohort, patients with preoperative renal insufficiency exhibited a higher incidence of complications following a radical cystectomy, and renal insufficiency was a significant risk factor for major complications.

Keywords: Clavien-Dindo; complications; radical cystectomy; renal function; renal insufficiency.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This paper was supported by the National Natural Science Foundation of China (grant numbers:81272829).