Describing the 90-day postoperative outcomes after open radical cystectomies and evaluating predictive nomograms at a South African referral centre
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Abstract
Purpose: Radical cystectomy (RC) is the primary treatment for muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer despite its significant morbidity and mortality rates. There is a need for tools, like nomograms, to help predict mortality following RCs. This study aimed to investigate outcomes and predictive tools (nomograms) in a South African cohort.
Methods: Between January 2014 and April 2022, 89 patients underwent RC at a high-volume centre in South Africa. We described the outcomes of these cases and evaluated the performance of the Aziz and Preoperative Score to Predict Postoperative Mortality (POSPOM) nomograms for predicting 90-day mortality in our population.
Results: Neoadjuvant chemotherapy was administered to 38% of patients, with 41% achieving a complete response. There was a median of 800 ml intraoperative blood loss, and 51.7% required blood transfusions. The median hospital stay post-surgery was ten days. Within one year post-surgery, 79.8% experienced complications, with major complications (Clavien–Dindo III–V) occurring in 15.7% of cases. The 30- and 90-day all-cause mortality rates were 5.6% and 9.0%, respectively. The Aziz nomogram demonstrated moderate predictive accuracy for 90-day mortality (area under the curve [AUC] = 0.749), while the POSPOM nomogram performed less effectively (AUC = 0.635).
Conclusions: This study shows marginally higher complication and mortality rates than high-income countries. The Aziz nomogram shows potential for identifying suitable surgical candidates in this setting.