Risk Factors for Early Postoperative Ileus Following Laparoscopic Radical Cystoprostatectomy.

Abstract

Early postoperative ileus (EPOI) delays recovery after radical cystectomy, but reported definitions and associated factors vary. This retrospective study evaluated 549 adults with bladder cancer who underwent curative-intent laparoscopic radical cystectomy and urinary diversion between January 2014 and December 2022. EPOI was defined by the presence of at least two prespecified clinical or radiological criteria between postoperative days 3 and 30. Candidate factors were evaluated using univariate analyses and multivariable logistic regression. Model discrimination and calibration were assessed, and 1,000-resample bootstrap internal validation was performed. An exploratory subgroup analysis assessed inflammatory markers measured within 24 h after surgery. EPOI occurred in 76 patients (13.84%). After multivariable adjustment, female sex was associated with lower odds of EPOI, whereas smoking history, diabetes mellitus, previous abdominal surgery, greater intraoperative blood loss, and higher lymph node yield were associated with higher odds. The apparent area under the receiver operating characteristic curve (AUC) of the primary model was 0.881, and the optimism-corrected AUC was 0.869. In the 138-patient inflammatory-marker subgroup, postoperative white blood cell count and C-reactive protein were higher in patients who subsequently met the prespecified EPOI criteria; white blood cell count showed exploratory discrimination with an AUC of 0.727. These findings identify patient- and surgery-related factors associated with EPOI, but the model, data-derived thresholds, and biomarker findings require prospective multicenter external validation before clinical use.