1414 COMPLICATIONS AND LONG-TERM RESULTS OF SALVAGE CYSTECTOMY AFTER FAILED BLADDER-SPARING THERAPY FOR MUSCLE-INVASIVE BLADDER CANCER (2012)

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 20121414 COMPLICATIONS AND LONG-TERM RESULTS OF SALVAGE CYSTECTOMY AFTER FAILED BLADDER-SPARING THERAPY FOR MUSCLE-INVASIVE BLADDER CANCER Jairam Eswara, Jason Efstathiou, Niall Heney, Jonathan Paly, Donald Kaufman, W. Scott McDougal, Francis McGovern, and William Shipley Jairam EswaraJairam Eswara Boston, MA More articles by this author , Jason EfstathiouJason Efstathiou Boston, MA More articles by this author , Niall HeneyNiall Heney Boston, MA More articles by this author , Jonathan PalyJonathan Paly Boston, MA More articles by this author , Donald KaufmanDonald Kaufman Boston, MA More articles by this author , W. Scott McDougalW. Scott McDougal Boston, MA More articles by this author , Francis McGovernFrancis McGovern Boston, MA More articles by this author , and William ShipleyWilliam Shipley Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy has been the standard for muscle-invasive bladder cancer. Combined-modality-therapy (CMT) involving transurethral resection of bladder tumor (TURBT), external-beam radiation, and chemotherapy is an effective alternative to cystectomy in selected patients. Salvage-cystectomy is reserved for those failing CMT. We characterized complications associated with salvage-cystectomy. METHODS From 1986-2007 of 348 patients undergoing bladder-sparing therapy, 102 patients (29%) underwent salvage-cystectomy, 91 performed at Massachusetts General Hospital following CMT for T2-T4aNxM0 bladder cancer. Patients underwent TURBT followed by chemoradiation (40Gy). Early assessment was performed by cystoscopy/rebiopsy. Patients with complete response continued with consolidation chemoradiation (total dose 64Gy). Immediate salvage-cystectomy (50/91) was performed for persistent disease, while delayed salvage-cystectomy (41/91) was performed for an invasive recurrence. Complications were classified using the Clavien system. RESULTS Median age was 69.4yrs (27.5-88.9); median living-patient follow-up was 12yrs (0-23). 99% (90/91) underwent ileal diversion. 69% (63/91) had complications of any grade <90 days. 16% (15/91) experienced major complications <90 days. 21% (19/91) required readmission <90 days. 90-day mortality was 2.2% (2/91). Significant cardiovascular/hematologic complications [PE, MI, DVT, transfusion] <90 days were more common in the immediate than delayed cystectomy group (37% vs. 15%, p=0.02). Tissue-healing complications [fascial dehiscence, wound infection, ureteral stricture, anastomotic stricture, stoma/loop revisions] were more common in the delayed than immediate cystectomy group (35% vs. 12%, p=0.05). CONCLUSIONS Salvage cystectomy is associated with acceptable morbidity, though complication rates are slightly higher than for other cystectomy series. Immediate cystectomies have more cardiovascular/hematologic complications, while delayed cystectomies have more tissue-healing complications. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e574 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jairam Eswara Boston, MA More articles by this author Jason Efstathiou Boston, MA More articles by this author Niall Heney Boston, MA More articles by this author Jonathan Paly Boston, MA More articles by this author Donald Kaufman Boston, MA More articles by this author W. Scott McDougal Boston, MA More articles by this author Francis McGovern Boston, MA More articles by this author William Shipley Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...