Salvage Radical Cystoprostatectomy and Orthotopic Urinary Diversion Following Radiation Failure

Abstract

Salvage surgery with orthotopic urinary reconstruction is a safe, effective procedure that provides a functional lower urinary tract in patients in whom definitive pelvic radiation therapy has failed.

Prognostic value of lymph-node dissection in patients undergoing radical cystectomy following previous oncological treatment for bladder cancer

“…Another, more plausible, explanation is the difficulties of dissection because of fibrosis surrounding the lymph nodes following the oncological treatment. Similar problems with performing LND in a previously irradiated pelvis was reported by Bochner et al [10]. In a series of 18 patients undergoing salvage RC, 11 patients had no LND because of surrounding desmoplastic reaction in the pelvis overlying the vessels and nodal tissue.…”

Management of prostate cancer recurrences after radiation therapy‐brachytherapy as a salvage option

“…10 A USC series described 18 patients who underwent salvage CP with 56% of patients able to retain continence after creation of an orthotopic neobladder. 11 A retrospective study of toxicities resulting from salvage radical prostatectomy performed at Memorial Sloan-Kettering Cancer Center (MSKCC) (n 5 100) reported an incontinence rate of 33% in patients operated on before 1993, with an improvement to 13% for patients operated on after this period. 12 Similarly, rectal injury rates were initially 15% but improved to 2% after 1993.…”

Radical cystectomy is the treatment of choice for invasive bladder cancer

“…[28][29][30][31][32] Ileal neobladders also become much more challenging following pelvic irradiation, with complication rates as high as 33% including prolonged urinary leakage, ureteral stenosis, fistulas, and urinary retention with a re-operation rate of 17% at 28 months and significant day and night incontinence rates of 33% and 44%, respectively. 35,36 One should also not overlook the long-term risk of secondary malignancies following radiotherapy as irradiating the pelvis (e.g., in patients with prostate cancer) has been shown to increase the rate of cancer with relative risks of bladder and rectal cancers of 1.88 and 1.26 for external beam radiotherapy, 1.52 and 1.08 for brachytherapy and 1.85 and 1.21 for external beam radiotherapy-brachytherapy compared to prostatectomy alone. 37 Lastly, although comparable results may be achieved in only select patients, patients with compromised renal function, hydronephrosis, concomitant carcinoma in situ (CIS) or large tumour burden will respond poorly to bladder preservation strategies with radiation.…”