International Multicentre Analysis of Perioperative Complications Following Major Urologic Oncologic Surgery: Early Results from More than 130 000 Procedures from the CAMUS Collaborative

Background and objective: Perioperative and postoperative complications after major urologic oncologic surgeries are common and clinically significant. Standardised complication grading and reporting are critical for benchmarking, quality improvement, and patient counselling. Our aim was to provide a comprehensive global assessment of complications following radical cystectomy (RC), radical and partial nephrectomy (RN and PN), radical prostatectomy (RP), radical nephroureterectomy (RNU), and retroperitoneal lymph node dissection (RPLND). Methods: This international, multicentre observational study included 130 034 procedures (29 098 RC, 75 001 RP, 24 476 major kidney surgery, 1459 RPLND) from 180 centres in 33 countries worldwide. Complications were graded using the Clavien-Dindo classification and quantified via the Comprehensive Complication Index, with descriptive analysis of complications at 30 d and 90 d. Key findings and limitations: Complication rates varied by procedure. RC had the highest morbidity, with 30-d grade I–II complication in 40% and grade III–V in 16%, and a 90-d mortality rate of 2.3%. RP had low complication rates (grade I–II: 10–15%; grade III–V: 5–8%; mortality <0.05%), although extended pelvic lymph node dissection increased the incidence of high-grade events to 10%. Morbidity and mortality were generally low after PN; 90-d mortality was higher with open RN, reaching 1.7%. RNU and RPLND had moderate rates of major complications (up to 14%) and low mortality (<1%). Retrospective data collection, potential heterogeneous reporting of complications between centres, and incomplete follow-up in some cases may affect the generalisability of the results. Conclusions and clinical implications: This standardised global data set is the largest assessment of perioperative morbidity across urologic oncologic procedures to date, and provides important real-world evidence. RC remains the most morbid procedure, while RP had markedly lower complication rates. Standardised reporting and international benchmarking are essential to improve surgical safety and guide quality improvement worldwide.