Utility of serum markers in the assessment of perioperative and postoperative morbidity and mortality after radical cystectomy

Aim of the study: Despite significant improvements in surgical techniques, radical cystectomy (RC) remains a highly morbid operation. The ability to predict complications and create prevention strategies is crucial in the surgical decision-making process and to optimise treatment outcomes. Recently, there is growing interest in the association of preoparetive inflammation and immuno-nutritional serum markers with postsurgical complications and survival out- comes. The aim of this study was to investigate and compare the ability of preoperative Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), neutrophil to lymphocyte ratio (NLR), platlet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII), albumin, fibrinogen and PCR to predict perioperative and postoperative morbidity and mortality after RC. Materials and methods: We retrospectively evaluated 164 patients who underwent open RC for muscle-invasive bladder cancer (MIBC) at our Institute between December 2004 and June 2018. We excluded those patients who received neoadjuvant therapy and patients in whom data were incomplete. Covariates were analyzed to determine associations with complication rates (according to the Clavien-Dindo system), mean hospitalization length, 30-days readmission rates and 90-days mortality. A multivariable binomial logistic regression determined associations with postsurgical outcomes taking into account age, sex, urinary diversion, pT stage and each serum marker, or American Society of Anesthesiologists (ASA) classification and Charlson Comorbity Index (CCI) categorization. Results: Cut-off values to discriminate threshold of these biomarkers were determined calculating the ROC curve and the maximum Youden index. We included 164 patients underwent RC for MIBC. The mean age at surgery was 72.1 years (range, 46–88) and the majority of urinary diversions were ileal conduit (78.1%). Overall, 44(26.8%) patients experienced a major complication (Clavien grade≥3) and there were 9(5.5%) deaths within 3 months of surgery. ASA, CONUT, NLR, PLR, SII and PCR showed statistically significant differences in distribution of complications (all p < 0.05). There were no differences in mean hospitalization length while CONUT, PNI, fibrinogen, PCR, SII and CCI were statistically associated with 30-days readmission. Fibrinogen was the only serum marker associated with 90-days mortality (p=0.01). Multivariable binomial logistic regression ana- lysys confirmed the association of CONUT, SII, ASA, NLR, PCR and fibrinogen with surgical complications (all p < 0.05). Discussion: Preoperative inflammation and immuno-nutritional serum markers based on standard laboratory measurements may be simple and inexpensive potentially effective risk-assessment tools to predict outcomes after RC. Further investigations should be necessary to confirm these results.