Prognostic Nutritional Index as a Predictor of Complications Following Robot-Assisted Radical Cystectomy

Objective The objective of this study is to assess how the preoperative prognostic nutritional index (PNI) affects the occurrence of postoperative complications in patients undergoing robot-assisted radical cystectomy (RARC). Methods We retrospectively analyzed data from 103 patients who underwent RARC at Jichi Medical University Hospital between June 2018 and December 2023. The PNI was calculated using the following formula: 10 × serum albumin + 0.005 × total lymphocyte count. Patients were divided into high- and low-PNI groups based on a threshold value of 45. Postoperative complications occurring within 30 days were compared between the two groups, and risk factors were identified using multivariate logistic regression analysis. Results Postoperative complications occurred in 50 patients (48.5%), with eight patients (8%) experiencing severe complications (Clavien-Dindo Grade ≥3). The most common complication was postoperative ileus, affecting 26% of patients (n = 28). The low-PNI group had significantly higher rates of overall complications (70% vs. 47%, p< 0.05) and postoperative ileus (48% vs. 18%, p < 0.05) compared to the high-PNI group. Multivariate analysis identified low PNI (ORs: 3.82 for overall complications and 3.90 for ileus) and intestinal urinary diversion (ORs: 3.33 and 5.34, respectively) as independent risk factors. Conclusions The preoperative PNI is a significant predictor of both overall complications and postoperative ileus following RARC. These findings underscore the importance of preoperative immunonutritional assessment for risk stratification and suggest that nutritional screening and immunonutritional interventions may enhance postoperative outcomes in high-risk patients.