How to predict the risk of complication or death after radical cystectomy?

Radical cystectomy represents nowadays the gold standard in the treatment of localized muscle-invasive bladder cancer and high risk non-muscle-invasive bladder cancer. On the other hand, the rate of morbidity and mortality remains significant despite the advances in perioperative management and postoperative care in recent years [1]. This is even more expressed with the fact that firstly, we talk about a disease affecting eldery people and secondly, the population is aging. Comorbities, and thus the risk of a complication or death, come with age that implies consideration of bladder sparing treatment like radiochemotherapy or partial cystectomy in these patients [2]. EAU guidelines recommend using the Charleson Comorbidity Index as an independent prognostic factor for perioperative mortality [2]. POSSUM and P-POSSUM provide tools for risk adjustment to predict morbidity and mortality which were developed and validated within the general surgical population. A retrospective multicenter study from Japan [3] validated both predictors on 280 patients operated on within a period of 9 years. The authors came to somewhat non-convincing results. POSSUM significantly underestiHow to predict the risk of complication or death after radical cystectomy?