Application of preoperative risk score in the choice of urinary diversion surgery for bladder cancer patients

Abstract:

Objective：To evaluate the value of preoperative risk score（PRS） for the choice of urinary diversion surgery of bladder cancer patients. Methods：The PRS and comprehensive complication index（CCI） of 303 bladder cancer patients who had undergone urinary diversion surgery（continent ileal reservoir-kock pouch，ileal conduit，cutaneous ureterostomy） from January 2012 to may 2017 in the First Affiliated Hospital of Chongqing Medical University were collected. The relationship between PRS and CCI in the same or different surgeries were analyzed，then the optimized PRS value to lessen the complications of the surgery was chosen，and quantitative evi－dence for the choice of urinary diversion surgery was provided. Results：PRS differed in three urinary diversion surgeries（the average PRS of cutaneous ureterostomy was 0.72±0.23，the average PRS of ileal conduit was 0.48±0.24，and the average PRS of continent ileal reservoir-kock pouch was 0.34±0.17，no statistical differences was observed in CCI between the three surgery（the average CCI of cutaneous ureterostomy was 38.19±16.34，the average CCI of ileal conduit was 36.04±11.17，and the average CCI of continent ileal reservoir-kock pouch was 38.14±13.36. According to the normal distribution principal，when taking the left 80% confidence interval，the postoperative complication out the interval was more serious than that in the interval. The value of left 80% confidence interval PRS was between 0.34 and 0.86 in cutaneous ureterostomy group，the average CCI which out the interval was obviously higher than that inside the interval，and significant differences were captured（P<0.01）. The value of left 80% confidence interval PRS was between 0.15 and 0.60 in ileal conduit group，the av－erage CCI which out the interval was obviously higher than that inside the interval，and significant differences were captured（P<0.01）. The value of left 80% confidence interval PRS was be－tween 0.14 and 0.42 in continent ileal reservoir-kock pouch group，the average CCI which out the interval was obviously higher than that inside the interval，and significant differences were cap－tured（P<0.05）. Conclusion：Continent ileal reservoir-kock pouch is not advised when PRS is beyond 0.42，ileal conduit is not ad－vised when PRS is beyond 0.60，cutaneous ureterostomy is not advised when PRS is beyond 0.86.