CUA 2017: Radical Cystectomy After Prior Partial Cystectomy for Urothelial Carcinoma: Perioperative and Oncological Outcomes

Toronto, Ontario ( Up to 50% of patients treated with partial cystectomy (PC) have been reported to require radical cystectomy (RC) due to local disease recurrence. The outcomes for these patients have not been well-described to date. Dr. Mason Ross presented a study evaluating outcomes of patients undergoing RC after PC for urothelial carcinoma (UC).

The authors identified 58 patients who underwent RC at our institution after prior PC for UC from 1980‒2010. These patients were then matched 1:3 to 174 patients undergoing primary RC based on age, pathologic T and N stage, and decade of surgery. Perioperative outcomes were compared between groups using descriptive statistics. Cancer-specific (CSS) and overall survival (OS) were evaluated using the Kaplan-Meier method and Cox proportional hazards regression.

Median age at the time of RC was 68 years in both groups (interquartile range [IQR] 62, 77). At a median follow-up time of 5 years after RC, a total of 91 patients were diagnosed with recurrence and 178 died (79 of urothelial carcinoma).  Estimated blood loss was similar among patients undergoing RC after PC compared to primary RC (median 800 cc vs. 700 cc; p=0.1), and there was no difference in operative time (median 322 min vs. 303 min; p=0.41), length of stay (median 9 vs. 10 days; p=0.09, or perioperative complications (63.8% vs. 58.6%; p=0.93). Five-year CSS was significantly worse for patients who underwent RC after PC vs. primary RC [HR] 2.28; 95% confidence interval [CI] 1.17, 4.42; while no difference in five-year OS was noted  HR 1.44; 95% CI 0.93-2.23.

In summary, patients who undergo RC for recurrent UC after prior PC have similar perioperative morbidity to stage-matched patients undergoing primary RC; however, such patients may be at a higher risk of subsequently dying from UC.  These data may be used in counselling patients considering PC as initial treatment for invasive UC, as well as for consideration of adjuvant therapy after RC following PC.

Presented By: Ross J. Mason, MD, Mayo Clinic, Rochester, MN, United States

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre   Twitter: @GoldbergHanan at the  72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada