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Updated: Sep 20, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Reporting and grading of complications for intracorporeal robot-assisted radical cystectomy: an in-depth short-term
Mikolaj Mendrek1, Jorn H Witt2, Sergey Sarychev3
1Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany. mikolaj.mendrek@gmail.com.
Objective:
To assess suitability of Comprehensive Complication Index (CCI®) vs. Clavien-Dindo classification (CDC) to capture 30-day morbidity after robot-assisted radical cystectomy (RARC).
Materials And Methods:
A total of 128 patients with bladder cancer (BCa) undergoing intracorporeal RARC with pelvic lymph node dissection between 2015 and 2021 were included in a retrospective bi-institutional study, which adhered to standardized reporting criteria. Thirty-day complications were captured according to a procedure-specific catalog. Each complication was graded by the CDC and the CCI®. Multivariable linear regression (MVA) was used to identify predictors of higher morbidity.
Results:
381 complications were identified in 118 patients (92%). 55 (43%), 43 (34%), and 20 (16%) suffered from CDC grade I-II, IIIa, and ≥ IIIb complications, respectively. 16 (13%), 27 (21%), and 2 patients (1.6%) were reoperated, readmitted, and died within 30 days, respectively. 31 patients (24%) were upgraded to most severe complication (CCI® ≥ 33.7) when calculating morbidity burden compared to corresponding CDC grade accounting only for the highest complication. In MVA, only age was a positive estimate (0.44; 95% CI = 0.03-0.86; p = 0.04) for increased cumulative morbidity.
Conclusion:
The CCI® estimates of 30-day morbidity after RARC were substantially higher compared to CDC alone. These measurements are a prerequisite to tailor patient counseling regarding surgical approach, urinary diversion, and comparability of results between institutions.
Insights
The Comprehensive Complication Index (CCI) captures significantly more 30-day morbidity after robot-assisted radical cystectomy (RARC) than the Clavien-Dindo classification (CDC). This improved assessment aids in patient counseling and institutional result comparison.
Area of Science:
- Urology
- Surgical Oncology
- Medical Informatics
Background:
- Robot-assisted radical cystectomy (RARC) is a complex procedure for bladder cancer.
- Accurate assessment of 30-day postoperative morbidity is crucial for patient outcomes and comparative analysis.
- Existing morbidity grading systems may not fully capture the cumulative burden of complications.
Purpose of the Study:
- To evaluate the suitability of the Comprehensive Complication Index (CCI) compared to the Clavien-Dindo classification (CDC) for assessing 30-day morbidity following RARC.
- To determine if CCI provides a more comprehensive measure of complications than CDC in this patient cohort.
Main Methods:
- A retrospective study included 128 patients undergoing intracorporeal RARC with pelvic lymph node dissection.
- Complications within 30 days were systematically recorded and graded using both CDC and CCI.
- Multivariable regression analysis identified predictors of increased morbidity.
Main Results:
- 381 complications were identified in 118 patients (92%).
- CCI identified 24% of patients with a higher morbidity burden (CCI ≥ 33.7) compared to CDC alone.
- Age was the only significant predictor of increased cumulative morbidity (p=0.04).
Conclusions:
- The CCI provides a substantially higher estimate of 30-day morbidity after RARC compared to the CDC alone.
- CCI's comprehensive assessment is essential for tailoring patient counseling and improving the comparability of RARC outcomes across institutions.
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