| Objectives:1.To describe the early complications of radical cystectomy(RC)with ureterosigmoidostomy(Mainz pouchⅡ)according to the modified Clavien-Dindo system,and to analyze risk factors for high-grade complications.2.To construct a clinical prediction model that can effectively predict the occurrence of major complications within 90 days after radical cystectomy with ureterosigmoidostomy.Methods:The clinical data of patients who underwent radical cystectomy with ureterosigmoidostomy from January 2017 to June 2022 in the Urology Department of Lanzhou University Second Hospital due to transitional cell carcinoma of the bladder were collected retrospectively.Firstly,the early postoperative complications were systematically described according to the modified Clavien system,and patients were divided into non-high-grade complication group(Clavien≤II complication)and high-grade complication group(any Clavien III-V complication).The optimal cut-off value of some continuous variables was determined by the Receiver Operating Characteristic Curve(ROC),and they were divided into high and low groups according to the optimal cut-off value.LASSO regression was used to screen variables and draw shrinkage graphs.Variables with coefficients not equal to 0 were included in multivariate logistic regression analysis to find independent risk factors for high-grade postoperative complications.R software was used to draw the nomogram of the multivariate Logistic regression model,the bootstrap method was used to internally validate the prediction model.The consistency and discrimination were calculated,and the clinical benefit was evaluated by decision curve analysis.Results:After excluding 18 patients lost to follow-up,a total of 150 patients who underwent radical cystectomy with ureterosigmoidostomy(Mainz pouchⅡ)were included in this study.The enrolled patients comprised of 121 males and 29 females,with a mean age of 61.5(±9)years.Among the patients,113 patients(75.3%)had organ-confined disease(p T1-2),and 37 patients(24.7%)had nonorgan-confined disease(p T3-4).Ninety-five patients(63.3%)experienced more than one complication within the first 90 days postoperatively.Among them,38.7%(58/150)of the patients had only minor complications(Clavien I-II),and 24.7%(37/150)of the patients had major complications(Clavien≥III).Of all observed complications,fever,ileus,and incisional complications were the most common.After LASSO regression and multivariate logistic regression analysis,it was found that body mass index(BMI≥24kg/m~2),preoperative albumin-to-globulin ratio(<1.55),more intraoperative bleeding and high abdominal drainage in 24 hours after operation are the independent risk factors for high-grade complications(all P<0.05).The formula of the model is as follows:logit P=-4.7405-0.4219×X1+0.5399×X2+1.4480×X3+1.2450×X4.(X1:intraoperative blood loss;X2:peritoneal drainage 24 hours after operation;X3:body mass index;X4:preoperative albumin-to-globulin ratio).Visualize the above formula and present it in the form of a nomogram.The area under the ROC curve(AUC)of the nomogram model was 0.798,suggesting that the prediction model has a strong predictive ability for the occurrence of high-grade complications after radical cystectomy with ureterosig-moidostomy;calibration curve and clinical decision curve demonstrate the good calibration ability and clinical utility of the model,respectively.Conclusions:The early morbidity of RC with ureterosigmoidostomy using a standardized reporting methodology remains acceptable.Although the incidence of some complications is different from that of other urinary diversions,the Mainz pouchⅡis perceived to be a relatively safe procedure.The nomogram prediction model constructed by body mass index,preoperative albumin-to-globulin ratio,estimated blood loss during operation and peritoneal drainage 24 hours after operation can be used as an important tool for clinicians to predict the early prognosis after radical cystectomy(RC)with ureterosigmoidostomy(Mainz pouchⅡ). |
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