Complications and Outcomes of Salvage Cystectomy after Trimodality Therapy

No AccessJournal of UrologyAdult Urology1 Jul 2021Complications and Outcomes of Salvage Cystectomy after Trimodality TherapyThis article is commented on by the following:Editorial Comment 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, and Matthew F. Wszolek Alberto PierettiAlberto Pieretti Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas , Ross KrasnowRoss Krasnow Department of Urology, MedStar Washington Hospital Center, Washington, D.C. , Michael DrummMichael Drumm Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Andrew GusevAndrew Gusev Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Douglas M. DahlDouglas M. Dahl Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Francis McGovernFrancis McGovern Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Michael L. BluteMichael L. Blute Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , William U. ShipleyWilliam U. Shipley Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Jason A. EfstathiouJason A. Efstathiou Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Adam S. FeldmanAdam S. Feldman Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , and Matthew F. WszolekMatthew F. Wszolek ‡Correspondence: Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 1102, Boston, Massachusetts 02114 telephone: 857-238-3838; FAX: 617-726-6131; E-mail Address: [email protected] Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts View All Author Informationhttps://doi.org/10.1097/JU.0000000000001696AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Salvage cystectomy is required for some patients with intravesical recurrence after trimodality therapy. We compared postoperative outcomes between salvage cystectomy post-trimodality therapy, primary cystectomy and primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy. Materials and Methods: We included 265 patients who underwent radical cystectomy at Massachusetts General Hospital for cT1-T4 bladder cancer between 2003 and 2013. Patients were grouped as salvage cystectomy post-trimodality therapy, primary cystectomy or primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy. Early (≤90 days) and late (>90 days) complications were compared. Disease-specific survival and overall survival were calculated using a Cox regression model, and adjusted survival curves were generated. Results: The median followup 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 salvage cystectomy post-trimodality therapy compared to primary cystectomy and primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy (p=0.03). In multivariable Cox regression analysis, salvage cystectomy post-trimodality therapy 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 disease-specific survival (p=0.8) or overall survival (p=0.9) between the groups. Conclusions: Salvage cystectomy post-trimodality therapy for intravesical recurrence post-trimodality therapy has an intraoperative and early complication rate comparable to primary cystectomy and primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy. Salvage cystectomy post-trimodality therapy is associated with a higher risk of overall and major late complications than primary cystectomy. The disease-specific survival and overall survival of patients who require salvage cystectomy post-trimodality therapy are comparable to both groups. 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Link, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Apr 2021Editorial Comment Volume 206Issue 1July 2021Page: 29-36 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordscystectomyurinary bladder neoplasmssalvage therapypostoperative complicationsMetricsAuthor Information Alberto Pieretti Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas More articles by this author Ross Krasnow Department of Urology, MedStar Washington Hospital Center, Washington, D.C. More articles by this author Michael Drumm Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Andrew Gusev Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Douglas M. Dahl Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Francis McGovern Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Michael L. Blute Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author William U. Shipley Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Jason A. Efstathiou Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Financial and/or other relationship with Boston Scientific, Blue Earth Diagnostics, Taris Biomedical. More articles by this author Adam S. Feldman Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Financial and/or other relationship with Olympus America, Inc., Roche Pharmaceuticals, Janssen Pharmaceuticals. More articles by this author Matthew F. Wszolek Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts ‡Correspondence: Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 1102, Boston, Massachusetts 02114 telephone: 857-238-3838; FAX: 617-726-6131; E-mail Address: [email protected] More articles by this author Expand All Advertisement PDF downloadLoading ...