Complication rate after cystectomy following pelvic radiotherapy: an international, multicenter, retrospective series of 682 cases.
Bladder cancer
Complications
Radiation therapy
Radical cystectomy
Urinary diversion
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
11
06
2019
accepted:
06
10
2019
pubmed:
7
11
2019
medline:
10
4
2021
entrez:
7
11
2019
Statut:
ppublish
Résumé
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. Patients treated with radical cystectomy following any previous history of RT and with available information on complications for a minimum of 1 year were included. Univariable and multivariable logistic regression models were used to assess the relationship between the variable parameters and the risk of any complication. 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. pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.
Identifiants
pubmed: 31691084
doi: 10.1007/s00345-019-02982-6
pii: 10.1007/s00345-019-02982-6
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1959-1968Investigateurs
Evanguelos Xylinas
(E)
Michael Rink
(M)
Références
Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19(3):666–675. https://doi.org/10.1200/jco.2001.19.3.666
doi: 10.1200/jco.2001.19.3.666
pubmed: 11157016
Novara G, De Marco V, Aragona M et al (2009) Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 182:914–921. https://doi.org/10.1016/j.juro.2009.05.032
doi: 10.1016/j.juro.2009.05.032
pubmed: 19616246
Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–176. https://doi.org/10.1016/j.eururo.2008.07.031
doi: 10.1016/j.eururo.2008.07.031
pubmed: 18675501
Chang SS, Alberts GL, Smith JA, Cookson MS (2004) Ileal conduit urinary diversion in patients with previous history of abdominal/pelvic irradiation. World J Urol 22(4):272–276. https://doi.org/10.1007/s00345-004-0446-4
doi: 10.1007/s00345-004-0446-4
pubmed: 15448995
Eisenberg MS, Dorin RP, Bartsch G, Cai J, Miranda G, Skinner EC (2010) Early complications of cystectomy after high dose pelvic radiation. J Urol 184(6):2264–2269. https://doi.org/10.1016/j.juro.2010.08.007
doi: 10.1016/j.juro.2010.08.007
pubmed: 20952024
Eswara JR, Efstathiou JA, Heney NM et al (2012) Complications and long-term results of salvage cystectomy after failed bladder sparing therapy for muscle invasive bladder cancer. J Urol 187(2):463–468. https://doi.org/10.1016/j.juro.2011.09.159
doi: 10.1016/j.juro.2011.09.159
pubmed: 22177159
Nguyen DP, Awamlh Al Hussein Al, Faltas BM et al (2015) Radical cystectomy for bladder cancer in patients with and without a history of pelvic irradiation: survival outcomes and diversion-related complications. Urology 86(1):99–107. https://doi.org/10.1016/j.urology.2015.02.061
doi: 10.1016/j.urology.2015.02.061
pubmed: 26142590
Ramani VAC, Maddineni SB, Grey BR, Clarke NW (2010) Differential complication rates following radical cystectomy in the irradiated and nonirradiated pelvis. Eur Urol 57(6):1058–1063. https://doi.org/10.1016/j.eururo.2009.12.002
doi: 10.1016/j.eururo.2009.12.002
pubmed: 20022162
Yee DS, Shariat SF, Lowrance WT et al (2010) Impact of previous radiotherapy for prostate cancer on clinical outcomes of patients with bladder cancer. J Urol 183(5):1751–1756. https://doi.org/10.1016/j.juro.2010.01.014
doi: 10.1016/j.juro.2010.01.014
pubmed: 20299035
pmcid: 4295901
Nieuwenhuijzen JA, Horenblas S, Meinhardt W, van Tinteren H, Moonen LMF (2004) Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer. BJU Int 94(6):793–797. https://doi.org/10.1111/j.1464-410X.2004.05034.x
doi: 10.1111/j.1464-410X.2004.05034.x
pubmed: 15476510
Edsmyr F, Moberger G, Wadström L (1971) Carcinoma of the bladder. Cystectomy after supervoltage therapy. Scand J Urol Nephrol 5(3):215–221. http://www.ncbi.nlm.nih.gov/pubmed/4998747 . Accessed 12 Jan 2018
Lund F (1980) Cystectomy following full course irradiation. Bladder tumors and other topics in urological oncology. Springer, Boston, pp 287–289. https://doi.org/10.1007/978-1-4613-3030-1_56
doi: 10.1007/978-1-4613-3030-1_56
Mitropoulos D, Artibani W, Graefen M et al (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349. https://doi.org/10.1016/j.eururo.2011.10.033
doi: 10.1016/j.eururo.2011.10.033
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. http://www.ncbi.nlm.nih.gov/pubmed/15273542 . Accessed 15 Jan 2018
Jayram G, Katz MH, Steinberg GD (2010) Radical cystectomy in patients previously treated for localized prostate cancer. Urology 76(6):1430–1433. https://doi.org/10.1016/j.urology.2010.01.048
doi: 10.1016/j.urology.2010.01.048
pubmed: 20381130
Vetterlein MW, Klemm J, Gild P et al (2019) Improving estimates of perioperative morbidity after radical cystectomy using the European Association of urology quality criteria for standardized reporting and introducing the comprehensive complication index. Eur Urol S0302–2838(19):30655
Aziz A, May M, Burger M et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66(1):156–163
doi: 10.1016/j.eururo.2013.12.018
Waingankar N, Mallin K, Smaldone M et al (2017) Assessing the relative influence of hospital and surgeon volume on short-term mortality after radical cystectomy. BJU Int 120(2):239–245
doi: 10.1111/bju.13804