Complication rate after cystectomy following pelvic radiotherapy: an international, multicenter, retrospective series of 682 cases
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.
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.
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.
pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.
KeywordsBladder cancer Radical cystectomy Radiation therapy Urinary diversion Complications
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.
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.
For this type of study, informed consent is not required.
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