Salvage Cystectomy after Radical Irradiation for Bladder Cancer–Prognostic Factors and Complications

Abstract

We have studied 46 patients who underwent salvage cystectomy between March 1981 and June 1992 for persistent or recurrent carcinoma after radical irradiation for bladder carcinoma. The overall 5-year survival rate was 43%. There was a higher 5-year survival rate in patients with an incomplete response compared with those with a complete response to their prior irradiation (50 and 36%), in patients with grades 1 or 2 compared with grade 3 histology (75 and 28%), and in patients with T1 or T2 tumours compared with T3 tumours (59 and 32%). The median interval between commencing irradiation and performing cystectomy was 11 months. In the 25 patients with a prior complete response the median interval was 16 months; this was statistically significantly longer than in the 21 patients with an incomplete response (median interval 7 months). A worsening of tumour grade and category was found in some patients when comparing the findings at cystectomy with those prior to irradiation. This was consistently higher in patients with a prior complete response than in those with an incomplete response. There were 3 deaths and 12 non-fatal major complications due to the prior irradiation or surgery, with a mortality rate of 7% and an overall 5-year complications rate of 35%. Only one of the complications occurred in the 13 patients treated with conventional 2 Gy fractions alone (5 fractions/week). Their overall complication rate was statistically significantly lower than that of the others. Salvage cystectomy is indicated for selected patients with persistent or recurrent disease after radical irradiation for bladder cancer. The expectation of a survival rate similar to that found in patients treated with immediate cystectomy may not be justified.

Cystectomy and urinary diversion as management of treatment‐refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes

“…reported 161 complications in 404 patients (40%) in the first 30 days after radical cystectomy, with 14% of patients experiencing a complication of Clavien grade III–V. Consistent with our outcomes for radiation‐induced fistula, radical cystectomy in radiated patients has been associated with a significantly increased complication rate relative to non‐radiated patients in several studies . The present results suggest that the morbidity of complete cystectomy for benign disease might be similar to that seen in radical cystectomy, and increased in the particularly complex and comorbid patients with radiation‐induced fistula.…”

“…For some complication analyses, patients were evaluated based on the preoperative condition of neurogenic bladder or radiation‐induced fistula. This was planned a priori based on differing rates of complications in the literature in management of these conditions . In addition, these cohorts were individually compared with a third non‐neurogenic, non‐radiation‐induced fistula cohort.…”

Early Complications of Cystectomy After High Dose Pelvic Radiation

“…(1993), отсутствие опухоли в макропрепарате (Р0) обеспечивало наилучшие показатели 5-летней общей выживаемости, достоверно превосходящие результаты лечения пациентов с резидуальной опухолью в мочевом пузыре (50 и 36 % соответственно). Другие исследователи отметили, что категория Р0 или мышечно-неинвазивный рак (Р1) были ассоциированы с большей 5-летней выживаемостью, чем мышечно-инвазивные новообразования (Р2-4а; 59-64 и 19-32 % соответственно) [6,15,16,18,19].…”

Long–Term Risk of Salvage Cystectomy after Radiotherapy for Muscle–Invasive Bladder Cancer

“…The salvage cystectomy rates reported in most radiotherapy series vary widely [6, 7]and therefore the cystectomy rate of 24% seen in this study is fairly typical. The 5–year survival rates of 42, 28 and 13% for T2, T3 and T4 tumours respectively are worse than those recently reported in a large review of patients treated with primary cystectomy as monotherapy between 1982 and 1994 [8], where rates were 63% for pT2, 53% pT3a, 33% pT3b and 28% for pT4, but it is well recognized that patient selection may account for the improved survival over radiotherapy seen in some surgical series.…”