Comparison of 90-day morbidity and mortality between ileal conduit and orthotopic neobladder following radical cystectomy in a large, multi-institutional database

The Canadian CBCis experience

Authors

  • Hanaa Fekak Université de Montréal
  • Wassim Kassouf McGill University
  • Rodney H. Breau University of Ottawa
  • Adrian Fairey Cross Cancer Centre
  • Agnihotram V. Ramanakumar McGill University
  • Camilla Tajzler McGill University
  • Eric Hyndman Alberta Health Services
  • Jasmir G. Nayak University of Manitoba
  • Jonathan Izawa Western University
  • Bobby Shayegan McMaster University
  • Girish S. Kulkarni University of Toronto
  • Afsaneh Eskandari University Health Network, Toronto
  • Michele Lodde Université Laval
  • Ricardo A. Rendon Dalhousie University
  • D. Robert Siemens Queen's University
  • Claudio Jeldres Université de Sherbrooke
  • Peter C. Black University of British Columbia
  • Jean-Baptiste Lattouf University of Montreal

DOI:

https://doi.org/10.5489/cuaj.9204

Keywords:

Bladder Cancer, Radical cystectomy, Ileal conduit, Orthotopic Neobladder, Complications, Mortality

Abstract

INTRODUCTION: In patients undergoing radical cystectomy, ileal conduit (IC) urinary diversions are more frequently carried out than orthotopic neo-bladder reconstructions (ONB). Patients selected for IC likely have more comorbidities, advanced disease, and older age, with many being poor candidates for ONB; ONB often ends up being selected by younger and healthier patients. Differences in complications experienced by IC and ONB patients may be due to differences between patients or urinary diversions. To guide patient counseling and care, we aimed to assess 90-day complications and mortality for patients undergoing either procedure in a large, contemporary, Canadian cohort.

METHODS: Patient information was obtained from the Canadian Bladder Cancer information system (CBCis), encompassing 14 academic Canadian centers. Patients who underwent radical cystectomy between February 2015 and September 2023 were included. Ninety-day complications were analyzed according to the Clavien-Dindo severity scale. Perioperative parameters and 90-day mortality were compared between IC and ONB diversion. We used rank-sum and Chi-squared exact tests as exploratory statistics. Unconditional logistic regression was used to evaluate the association between IC and ONB complications.

RESULTS: Of 2161 patients, 1799 (83%) received an IC and 362 (17%) an ONB. Patients were followed for a median of 235 days (interquartile range [IQR] 486). The median age was 69 years (IQR 14). The age-adjusted Charlson comorbidity index was significantly higher in the IC group (median [IQR] 5 [2] vs. 4 [2], p<0.001). The 90-day complication rate was 46% and the 90-day mortality rate was 4.3% for the entire cohort. On multivariable logistic regression, the risk of overall complications was significantly higher in the ONB than in the IC group (odds ratio 2.2, 95% confidence interval 1.7-2.8, p<0.001). Ninety-day mortality was 4.9% in the IC group and 0.82% in the ONB group.

CONCLUSIONS: In this multi-institutional cohort, patients with ONB had higher odds of perioperative complications; however, there was no difference in higher-severity complications between diversions.

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Published

2025-09-23

How to Cite

Fekak, H., Kassouf, W., Breau, R. H., Fairey, A., Ramanakumar, A. V., Tajzler, C., … Lattouf, J.-B. (2025). Comparison of 90-day morbidity and mortality between ileal conduit and orthotopic neobladder following radical cystectomy in a large, multi-institutional database: The Canadian CBCis experience. Canadian Urological Association Journal, 20(1), E1–7. https://doi.org/10.5489/cuaj.9204

Issue

Vol. 20 No. 1 (2026): CUAJ January

Section

Original Research

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