OBJECTIVE - To determine the safety of robot-assisted cystectomy in patients with an irradiated pelvis, by comparing perioperative complication outcomes after robot-assisted cystectomy in patients with and without a history of pelvic irradiation.
PATIENTS AND METHODS - A total of 252 consecutive patients underwent robot-assisted cystectomy at a tertiary referral center from 2002 and 2013. Of all patients, 46 (18%) had a history of pelvic irradiation. ● Complications occurring within 30 days and 90 days of surgery were graded using the modified Clavien classification system and additionally categorized by organ system. ● Baseline variables and outcomes of irradiated and non-irradiated patients were compared using descriptive statistics. Multivariable logistic regression models were generated to test the effect of previous pelvic irradiation on complications.
RESULTS - The indications for robot-assisted cystectomy in patents with a history of pelvic irradiation were: bladder cancer (n=30, 65%), prostate cancer (n=2, 4%), fistulas (n=5, 11%) and intractable symptoms from radiation cystitis (n=9, 20%). ● A total of 25 (54%) irradiated and 112 (54%) non-irradiated patients had complications within 90 days (p>0.9), of which 11 (24%) and 43 (21%) had major complications (p=0.7). ● One (2%) patient with and two (1%) patients without a history of irradiation died from surgical complications (p=0.5). ● Infectious, bleeding and gastrointestinal complications were the most common events in both groups. ● In multivariable analyses, a history of pelvic irradiation was not associated with higher risk of complications.
CONCLUSIONS - Robot-assisted cystectomy performed by an experienced surgeon is a reasonable option in selected patients with a history of pelvic irradiation, as complication rates do not significantly differ compared to non-irradiated patients. This article is protected by copyright. All rights reserved.
BJU international. 2016 Mar 02 [Epub ahead of print]
Bashir Al Hussein Al Awamlh, Daniel P Nguyen, Brandon Otto, Padraic O'Malley, Farehin Khan, Savanah Brooks, Douglas S Scherr
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York.