Systematic assessment of early complications after radical cystectomy for non–muscle-invasive bladder cancer and bladder cancer with minimal intradetrusor invasion at a single center

BACKGROUND: Bladder cancer ranks tenth among all malignant neoplasms worldwide, with about 573,300 newly diagnosed cases and about 212,500 deaths annually. Patients with very high-risk non–muscle-invasive bladder cancer, as well as those with tumor progression, are eligible for the same treatment as patients with muscle-invasive bladder cancer—namely, immediate radical cystectomy.

AIM: This study aimed to assess morbidity in patients undergoing radical cystectomy for non–muscle-invasive bladder cancer and bladder cancer with minimal muscle invasion.

METHODS: The study analyzed outcomes of radical treatment in 151 patients who underwent radical cystectomy. Based on postoperative pathological examination, two study groups were formed: group 1 included 49 patients with non–muscle-invasive bladder cancer (pT1 stage), and group 2 included 102 patients with bladder cancer with minimal muscle invasion (pT2a stage).

RESULTS: Early postoperative complications not related to urinary diversion were observed in 44.9% of patients in group 1 and in 32.4% of patients in group 2 (p = 0.135). The incidence of these complications was 77.6 ± 12.6 versus 51.0 ± 7.1 cases per 100 patients in the comparison groups, respectively (p > 0.05). Urinary diversion–related complications occurred in 13.3% and 16.7% of patients in groups 1 and 2, respectively. The incidence of these complications in groups 1 and 2 was 14.3 ± 5.4 and 16.6 ± 4.0 cases per 100 patients, respectively. At the same time, significant differences were identified in the distribution of patients across Clavien–Dindo complication grades 1, 2–3a, 3b, and more severe complications: 43.5%, 21.7%, and 34.8% in group 1, and 23.8%, 42.9%, and 33.3% in group 2, respectively (p = 0.0025).

CONCLUSION: Substantial differences in the pattern of early postoperative complications after radical cystectomy were identified in the pT1 group, likely attributable to multiple prior organ-sparing interventions and other treatment modalities. In addition, more severe Clavien–Dindo complications were more frequently observed in the pT2a group compared with group 1.