Grading complication following radical cystectomy and ileal conduit for bladder cancer using Clavien grading system

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system. Study Design: An analytical descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010. Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics. Results: Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients (56.2%) did not have any complications. Most common complication of wound infection was seen in 7 patients (CG-2), followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia (GC-3a). Mortality rate was 4.5%, classified as CG-V. Conclusion: Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life.