Cem KEZER, Mehmet Fatih AKBULUT, Ömer SARILAR, Ufuk ÇAĞLAR, Mücahit GELMİŞ, Faruk ÖZGÖR

Açık Radikal Sistektomi Sonrası Eviserasyona Etki Eden Faktörler

Giriş: Açık radikal sistektomiden (ORC) sonra eviserasyon için prediktif faktörleri netleştirmek. Yöntemler: 2017-2021 yılları arasında ORC uygulanan hastaların çizelgeleri geriye dönük olarak incelendi. Hastaların demografik özellikleri ve ameliyat sonuçları kaydedildi. ORC uygulanan hastalar eviserasyon gelişen hastalar (Grup 1) ve eviserasyon gelişmeyen hastalar (Grup 2) olarak iki gruba ayrıldı. Gruplar hasta preoperatif özellikleri, intraoperatif parametreler ve postoperatif sonuçlara göre karşılaştırıldı. Bulgular: Toplam 164 hasta çalışmaya dahil edilme kriterlerini karşıladı ve eviserasyonlu 24 hasta ve eviserasyonsuz 140 hasta sırasıyla Grup 1 ve Grup 2'ye alındı. Buna karşılık, eviserasyon olan hastalarda diabetes mellitus varlığı anlamlı olarak daha yüksekti (%25.0 ve %5.7 p= 0.002) ve yine bu hastalarda VKİ anlamlı olarak daha yüksekti (28.8 kg/m2 ve 24.9 kg/m2, p= 0.001). Ayrıca evisere olmayan hastalarda preoperatif albümin düzeyi anlamlı olarak daha yüksekti (p= 0.001). Ayrıca eviserasyonlu hastalarda ameliyat süresi anlamlı olarak daha uzundu (332.5 dk ve 268.3 dk, p= 0.001) ve eviserasyonlu hastalarda lenf nodu pozitifliği anlamlı olarak daha yüksekti (%50.0 ve %26.4, p= 0.020). Çok değişkenli regresyon analizi, daha yüksek BMI, daha düşük preoperatif albümin seviyesi ve daha uzun operasyon süresinin ORC sonrası eviserasyon ile anlamlı şekilde ilişkili olduğunu ortaya koydu. Ayrıca, diabetes mellitus varlığı, ORC'yi takiben eviserasyon riskini yedi kat arttırdı. Sonuç: Bu çalışma ilk kez daha yüksek BMI, daha düşük preoperatif albümin seviyesi, daha uzun operasyon süresi ve diabetes mellitus varlığının ORC sonrası eviserasyon için prediktif faktörler olduğunu göstermiştir.

Anahtar Kelimeler:

mesane kanseri, komplikasyon, eviserasyon, radikal sistektomi

Factors Affecting Evisceration Following Open Radical Cystectomy

Introduction: To clarify predictive factors for evisceration after open radical cystectomy (ORC). Methods: Charts for patients who underwent ORC between 2017 and 2021 were reviewed retrospectively. Patient demographic characteristics and operative outcomes were recorded. Patients who underwent ORC were divided into two groups as patients who developed evisceration (Group 1) and patients who did not develop evisceration (Group 2). The groups were compared according to patient preoperative characteristics, intraoperative parameters and postoperative outcomes. Results: Total, 164 patients met study inclusion criteria, and 24 patients with evisceration and 140 patients without evisceration were enrolled into Group 1 and Group 2, respectively. In contrast, the presence of diabetes mellitus was significantly higher in eviscerated patients (25.0% and 5.7% p= 0.002), and eviscerated patients had significantly higher BMI (28.8 kg/m2 and 24.9 kg/m2, p= 0.001). Also, non-eviscerated patients had significantly higher preoperative albumin level (p= 0.001). Moreover, the operation time was significantly longer in patients with evisceration (332.5 min and 268.3 min, p= 0.001) and lymph node positivity was significantly higher in patients with evisceration (50.0% and 26.4%, p= 0.020). Multivariate regression analysis revealed that higher BMI, lower preoperative albumin level, and longer operation time were significantly associated with evisceration after ORC. Also, the presence of diabetes mellitus increased the risk of evisceration seven-fold following ORC. Conclusion: Present study showed for the first time that higher BMI, lower preoperative albumin level, longer operation time and presence of diabetes mellitus were predictive factors for evisceration following ORC.

Keywords:

bladder cancer, complication, evisceration, radical cystectomy,

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