Preoperative predictions of postoperative complications in patients undergoing radical cystectomy; can a pre-operational tomography assisted pelvic diameter measurement have an effect on surgery and patient results?

BACKGROUND: In this study, the effectiveness of pelvic diameters in determining postoperative complications in patients who underwent radical cystectomy + urinary diversion operation due to muscle invasive or high-risk bladder tumor was investigated retrospectively. In addition, it was spesific aimed to predict the factors that may affect the operative difficulty and possible complications before the operation. METHODS: Demographic information of 79 male patients who underwent radical cystectomy with the diagnosis of bladder cancer between September 2012 and March 2020 in our clinic was recorded. Measurements describing pelvic dimensions; upper conjugate (UC), lower conjugate (LC), pelvic depth (PD), apical depth (AD), interspinous distance (ISD), bone femoral (BFW) and soft tissue width (SW) were measured by preoperative CT. ISD, BFW, SW indexes were defined as ISD/AD, BFW/AD, SW/AD, respectively. The results reported in the pathology report, complications and types according to the postoperative Clavien-Dindo complication system, and patients with mortality within 90 days were recorded. As indicators of operative difficulty in the radical cystectomy procedure; operative time, perioperative estimated blood loss, hospital stay were evaluated. Operative difficulty, positive surgical margins, in order to predict mortality and complications that may develop within 90 days; the findings are evaluated through multiple linear regression and binary logistic regression analyses in SPSS 23.0.0. software environment. FINDINGS: While complications were observed in 8 patients perioperatively, number of 96 complications were observed in 52 of 79 patients within ninety days (%65,8). As a result of correlation analysis, it was observed that there was a statistically significant correlation between the duration of the operation and the measurement of SA and BMI (p=0.011; p<0.001, respectively) and a statistically significant correlation between the amount of perioperative bleeding and the LC measurement of the patients and the preoperative HCT (p=0.047; p=0.022 respectively). Charlson comorbidity score for ninety-day mortality, BMI and Charlson comorbidity scores for severe complication, ISD INDEX, pathological T stage and Charlson comorbidity scores for surgical margin positivity were found to be significant predictors after logistic regression analysis. CONCLUSIONS: In this study, it appears that anatomical variations in the pelvis, such as narrow and deep pelvis, are not an important factor in terms of operative difficulty, presence of complications or ninety-day mortality, while patient-related features such as Charlson comorbidity score and BMI seem to increase mortality. It is also seen that the risk of positive surgical margins increases in patients with narrow and deep pelvis. Key Words: Charlson comorbidity score, Pelvis, Postoperative complication, Radical cystectomy, Surgical margin.