1. Complication rate after cystectomy following pelvic radiotherapy: an international, multicenter, retrospective series of 682 cases
- Author
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Gontero, P, Pisano, F, Palou, J, Joniau, S, Albersen, M, Colombo, R, Briganti, A, Pellucchi, F, Faba, OR, van Rhijn, BW, van de Putte, EF, Babjuk, M, Fritsche, HM, Mayr, R, Albers, P, Niegisch, G, Anract, J, Masson-Lecomte, A, De la Taille, A, Roupret, M, Peyronnet, B, Cai, T, Witjes, AJ, Bruins, M, Baniel, J, Mano, R, Lapini, A, Sessa, F, Irani, J, Brausi, M, Stenzl, A, Karnes, JR, Scherr, D, O'Malley, P, Taylor, B, Shariat, SF, Black, P, Abdi, H, Matveev, VB, Samuseva, O, Parekh, D, Gonzalgo, M, Vetterlein, MW, Aziz, A, Fisch, M, Catto, J, Pang, KH, Xylinas, E, Rink, M, Young Acad Urologists Urothel, Gontero, P., Pisano, F., Palou, J., Joniau, S., Albersen, M., Colombo, R., Briganti, A., Pellucchi, F., Faba, O. R., van Rhijn, B. W., van de Putte, E. F., Babjuk, M., Fritsche, H. M., Mayr, R., Albers, P., Niegisch, G., Anract, J., Masson-Lecomte, A., De la Taille, A., Roupret, M., Peyronnet, B., Cai, T., Witjes, A. J., Bruins, M., Baniel, J., Mano, R., Lapini, A., Sessa, F., Irani, J., Brausi, M., Stenzl, A., Karnes, J. R., Scherr, D., O'Malley, P., Taylor, B., Shariat, S. F., Black, P., Abdi, H., Matveev, V. B., Samuseva, O., Parekh, D., Gonzalgo, M., Vetterlein, M. W., Aziz, A., Fisch, M., Catto, J., Pang, K. H., Xylinas, E., and Rink, M.
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,Internationality ,Complications ,Urology ,medicine.medical_treatment ,Urinary Bladder ,030232 urology & nephrology ,Cystectomy ,Risk Assessment ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Postoperative Complications ,Internal medicine ,Medicine ,Humans ,Urinary diversion ,Aged ,Retrospective Studies ,Bladder cancer ,business.industry ,Radiation therapy ,Radical cystectomy ,Middle Aged ,medicine.disease ,Surgery ,Urinary Bladder Neoplasms ,030220 oncology & carcinogenesis ,Relative risk ,Abdominal Neoplasms ,Female ,business ,Complication - Abstract
Purpose: Conflicting evidence exists on the complication rates after cystectomy following previous radiation (pRTC) with only a few available series. We aim to assess the complication rate of pRTC for abdominal–pelvic malignancies. Methods: Patients treated with radical cystectomy following any previous history of RT and with available information on complications for a minimum of 1year were included. Univariable and multivariable logistic regression models were used to assess the relationship between the variable parameters and the risk of any complication. Results: 682 patients underwent pRTC after a previous RT (80.5% EBRT) for prostate, bladder (BC), gynecological or other cancers in 49.1%, 27.4%, 9.8% and 12.9%, respectively. Overall, 512 (75.1%) had at least one post-surgical complication, classified as Clavien ≥ 3 in 29.6% and Clavien V in 2.9%. At least one surgical complication occurred in 350 (51.3%), including bowel leakage in 6.2% and ureteric stricture in 9.4%. A medical complication was observed in 359 (52.6%) patients, with UTI/pyelonephritis being the most common (19%), followed by renal failure (12%). The majority of patients (86%) received an incontinent urinary diversion. In multivariable analysis adjusted for age, gender and type of RT, patients treated with RT for bladder cancer had a 1.7 times increased relative risk of experiencing any complication after RC compared to those with RT for prostate cancer (p = 0.023). The type of diversion (continent vs non-continent) did not influence the risk of complications. Conclusion: pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.
- Published
- 2020