Articles

Bladder Cancer

Differential Complication Rates Following Radical Cystectomy in the Irradiated and Nonirradiated Pelvis

By: Vijay A.C. Ramania b lowast , Satish B. Maddinenia c, Ben R. Greya c and Noel W. Clarkea c

European Urology, Volume 57 Issue 1, June 2010, Pages 1058-1063

Published online: 01 June 2010

Keywords: Bladder cancer, Cystectomy, Radiotherapy, Postradiotherapy salvage cystectomy, Pelvic exenteration, Urinary diversion, Postoperative complications

Abstract Full Text Full Text PDF (243 KB)

Abstract

Background

Reports suggest that cystectomy following pelvic irradiation is associated with a higher morbidity and mortality than in primary cases. However, such reports are from an era when postcystectomy complication rates were higher than are currently reported.

Objective

This study evaluates perioperative complications and mortality in primary radical and postradiation salvage cystectomy.

Design, setting, and participants

Patients treated with cystectomy for bladder cancer or advanced pelvic malignancies involving the bladder were studied.

Measurements

Perioperative complications and mortality were analysed for 426 primary and 420 salvage cystectomies performed at a single institution between 1970 and 2005.

Results and limitations

The 30- and 60-d mortality in the 2000–2005 cohort were 0% and 1.2%, respectively, in the primary group and 1.4% and 4.3%, respectively, in the salvage cystectomy group. Thirty-day mortality between 1970 and 2005 was not statistically significant in the primary and salvage groups (4.2% and 7.1%, respectively).

Conclusions

This large series from a high-volume centre demonstrates no difference in perioperative mortality in primary or postradiation salvage radical cystectomy. Similarly, there was no significant difference in the incidence of most of the surgical or medical complications in either group, although the stomal stenosis rate was higher postradiation.

Take Home Message

Salvage cystectomy following primary radical radiotherapy for treatment failure is believed to have higher morbidity than primary surgery. Our series of 846 cases over 35 yr demonstrates no significant difference in perioperative morbidity or mortality between the groups.

Keywords: Bladder cancer, Cystectomy, Radiotherapy, Postradiotherapy salvage cystectomy, Pelvic exenteration, Urinary diversion, Postoperative complications.

Footnotes

a The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom

b The University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom

c Salford Royal NHS Foundation Trust, Salford, United Kingdom

lowast Corresponding author. The Christie Hospital Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK. Tel. +44 161 446 3363.

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