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Complication rate after cystectomy following pelvic radiotherapy: an international, multicenter, retrospective series of 682 cases

  • Paolo Gontero
  • Francesca PisanoEmail author
  • Joan Palou
  • Steven Joniau
  • Maarten Albersen
  • Renzo Colombo
  • Alberto Briganti
  • Federico Pellucchi
  • Oscar Rodriguez Faba
  • Bas W. van Rhijn
  • Elies Fransen van de Putte
  • Marko Babjuk
  • Hanz Martin Fritsche
  • Roman Mayr
  • Peter Albers
  • Gunter Niegisch
  • Julien Anract
  • Alexandra Masson-Lecomte
  • Alexandre De la Taille
  • Morgan Roupret
  • Benoit Peyronnet
  • Tomaso Cai
  • Alfred J. Witjes
  • Max Bruins
  • Jack Baniel
  • Roy Mano
  • Alberto Lapini
  • Francesco Sessa
  • Jaques Irani
  • Maurizio Brausi
  • Arnulf Stenzl
  • Jeffrey R. Karnes
  • Douglas Scherr
  • Padraic O’Malley
  • Benjamin Taylor
  • Shahrokh F. Shariat
  • Peter Black
  • Hamidreza Abdi
  • Vsevolod B. Matveev
  • Olga Samuseva
  • Dipen Parekh
  • Mark Gonzalgo
  • Malte W. Vetterlein
  • Atiqullah Aziz
  • Margit Fisch
  • James Catto
  • Karl H. Pang
  • Evanguelos Xylinas
  • Michael Rink
  • the Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology
Original Article

Abstract

Purpose

Conflicting evidence exists on the complication rates after cystectomy following previous radiation (pRTC) with only a few available series. We aim to assess the complication rate of pRTC for abdominal–pelvic malignancies.

Methods

Patients treated with radical cystectomy following any previous history of RT and with available information on complications for a minimum of 1 year were included. Univariable and multivariable logistic regression models were used to assess the relationship between the variable parameters and the risk of any complication.

Results

682 patients underwent pRTC after a previous RT (80.5% EBRT) for prostate, bladder (BC), gynecological or other cancers in 49.1%, 27.4%, 9.8% and 12.9%, respectively. Overall, 512 (75.1%) had at least one post-surgical complication, classified as Clavien ≥ 3 in 29.6% and Clavien V in 2.9%. At least one surgical complication occurred in 350 (51.3%), including bowel leakage in 6.2% and ureteric stricture in 9.4%. A medical complication was observed in 359 (52.6%) patients, with UTI/pyelonephritis being the most common (19%), followed by renal failure (12%). The majority of patients (86%) received an incontinent urinary diversion. In multivariable analysis adjusted for age, gender and type of RT, patients treated with RT for bladder cancer had a 1.7 times increased relative risk of experiencing any complication after RC compared to those with RT for prostate cancer (p = 0.023). The type of diversion (continent vs non-continent) did not influence the risk of complications.

Conclusion

pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.

Keywords

Bladder cancer Radical cystectomy Radiation therapy Urinary diversion Complications 

Notes

Acknowledgements

The members of the Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology are: Evangelous Xylinas and Michael Rink. The authors declare that the development of the manuscript was not supported by an honorarium, a grant, or any other sources of support, including sponsorship or any material sources of support.

Author contributions

Project development: PG, JP, SS, SJ, AW, RC, BR, MB, JC. Data management: FP, MR, EX. Data collection: AM, BA, PF, RFO, EFP, FHM, MR, AP, NG, AJ, M-LA, TA, RM, BP, CT, BM, BJ, MR, LA, SF, IJ, BM, SA, KRJ, SD, OP, TB, BP, AH, MVB, SO, PD, GM, VMW, AA, FM, PKH. Data analysis: MR. Manuscript writing/editing: PG, JP, EX.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

For this type of study, informed consent is not required.

Supplementary material

345_2019_2982_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Paolo Gontero
    • 1
  • Francesca Pisano
    • 1
    • 2
    Email author
  • Joan Palou
    • 2
  • Steven Joniau
    • 3
  • Maarten Albersen
    • 3
  • Renzo Colombo
    • 4
  • Alberto Briganti
    • 4
  • Federico Pellucchi
    • 4
  • Oscar Rodriguez Faba
    • 2
  • Bas W. van Rhijn
    • 5
  • Elies Fransen van de Putte
    • 5
  • Marko Babjuk
    • 6
  • Hanz Martin Fritsche
    • 7
  • Roman Mayr
    • 7
  • Peter Albers
    • 8
  • Gunter Niegisch
    • 8
  • Julien Anract
    • 9
  • Alexandra Masson-Lecomte
    • 10
  • Alexandre De la Taille
    • 11
  • Morgan Roupret
    • 12
  • Benoit Peyronnet
    • 12
  • Tomaso Cai
    • 13
  • Alfred J. Witjes
    • 14
  • Max Bruins
    • 14
  • Jack Baniel
    • 15
  • Roy Mano
    • 15
  • Alberto Lapini
    • 16
  • Francesco Sessa
    • 16
  • Jaques Irani
    • 17
  • Maurizio Brausi
    • 18
  • Arnulf Stenzl
    • 19
  • Jeffrey R. Karnes
    • 20
  • Douglas Scherr
    • 21
  • Padraic O’Malley
    • 21
  • Benjamin Taylor
    • 21
  • Shahrokh F. Shariat
    • 22
  • Peter Black
    • 23
  • Hamidreza Abdi
    • 23
  • Vsevolod B. Matveev
    • 24
  • Olga Samuseva
    • 24
  • Dipen Parekh
    • 25
  • Mark Gonzalgo
    • 25
  • Malte W. Vetterlein
    • 26
  • Atiqullah Aziz
    • 27
  • Margit Fisch
    • 26
  • James Catto
    • 28
  • Karl H. Pang
    • 28
  • Evanguelos Xylinas
    • 9
  • Michael Rink
    • 26
  • the Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology
    • 26
  1. 1.Department of Urology, Molinette HospitalUniversity of Torino School of MedicineTurinItaly
  2. 2.Department of Uro-oncolgyFundacio Puigvert, University of BarcelonaBarcelonaSpain
  3. 3.Oncologic and Reconstructive Urology, Department of UrologyUniversity Hospitals LeuvenLouvainBelgium
  4. 4.Unit of Urology/Division of OncologyURI, IRCCS Ospedale San RaffaeleMilanItaly
  5. 5.Netherland Cancer InstituteAmsterdamThe Netherlands
  6. 6.Department of UrologyMotol Hospital, University of PrahaPragueCzech Republic
  7. 7.Department of UrologyRegensburg UniversityRegensburgGermany
  8. 8.Department of UrologyHeinrich-Heine-University, Medical FacultyDüsseldorfGermany
  9. 9.Department of UrologyCHU BichatParisFrance
  10. 10.Department of UrologyHôpital Saint-Louis, Université Paris-DiderotParisFrance
  11. 11.Department of UrologyHenri Mondor Academic HospitalCreteilFrance
  12. 12.Department of UrologyHôpital La Pitié-SalpétrièreParisFrance
  13. 13.Department of UrologyOspedale S. ChiaraTrentoItaly
  14. 14.Department of UrologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  15. 15.Department of UrologyRabin Medical CentreTel AvivIsrael
  16. 16.Department of UrologyUniversity of Florence, University Hospital of FlorenceFlorenceItaly
  17. 17.Department of Urology, Kremlin-Bicetre HospitalAssistance Publique Hôpitaux de ParisParisFrance
  18. 18.Department of UrologyOspedale di Carpi-ModenaModenaItaly
  19. 19.Department of UrologyUniversity Hospital TübingenTübingenGermany
  20. 20.Department of UrologyMayo ClinicRochesterUSA
  21. 21.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA
  22. 22.Department of UrologyMedical University of ViennaViennaAustria
  23. 23.Department of Urologic SciencesUniversity of British ColumbiaVancouverCanada
  24. 24.Department of UrologyN.N. Blokhin Russian Cancer Research CenterMoscowRussia
  25. 25.Department of UrologyUniversity of Miami Miller School of MedicineMiamiUSA
  26. 26.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  27. 27.Department of UrologyUniversity Medical Center RostockRostockGermany
  28. 28.Academic Urology UnitUniversity of SheffieldSheffieldUK

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