Complications and Outcomes of Salvage Cystectomy after Trimodality Therapy.

Salvage cystectomy is required for some patients with intravesical recurrence after trimodality therapy (TMT). We compared postoperative outcomes between salvage cystectomy post-TMT (SC), primary cystectomy (PC), and primary cystectomy with prior history of non-TMT abdominal or pelvic radiotherapy (PC with Hx XRT).

265 patients were included who underwent radical cystectomy (RC) at Massachusetts General Hospital for cT1-T4 bladder cancer between 2003 to 2013. Patients were grouped as SC, PC, or PC with Hx XRT. Early (≤90 days) and late (>90 days) complications were compared. Disease-specific survival (DSS) and overall survival (OS) OS were calculated using a Cox regression model, and adjusted survival curves were generated.

The median follow-up from the time of cystectomy was 65.5 months. There was no difference in intraoperative and early complications between the groups. The detection of late complications was higher in SC compared to PC and PC with Hx XRT (p=0.03). In multivariable Cox regression analysis, SC was associated with a higher incidence of any late (HR 2.3, p=0.02) and major late complications (HR 2.1, p <0.05). There was no difference in DSS or OS between the groups [(p=0.8); (p=0.9)].

SC for intravesical recurrence post-TMT has an intraoperative and early complication rate comparable to PC and PC with Hx XRT. SC is associated with a higher risk of overall and major late complications than PC. The DSS and OS of patients that require SC are comparable to both groups.

The Journal of urology. 2021 Feb 22 [Epub ahead of print]

Alberto Pieretti, Ross Krasnow, Michael Drumm, Andrew Gusev, Douglas M Dahl, Francis McGovern, Michael L Blute, William U Shipley, Jason A Efstathiou, Adam S Feldman, Matthew F Wszolek

Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, MedStar Washington Hospital Center, Washington, District of Columbia., Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

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