Back to 2011 Program

Introduction: Radical cystectomy has been the gold 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.
Materials & Methods: From 1986-2007 of 285 patients undergoing undergoing bladder-sparing therapy, 91 patients (32%) underwent salvage cystectomy at our institution 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. Medical records were reviewed classifying complications using the Clavien system.
Results: Median age was 69.4yrs (27.5-88.9), median follow-up was 20mos (0-252). 99% (90/91) underwent ileal diversion. 69% (63/91) had complications of any grade within 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 cystectomy group (37% vs. 15%, p=0.02). Tissue-healing complications [fascial dehiscence, wound infection, ureteral stricture, anastamotic stricture, stoma/loop revisions] were more common in the delayed 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 CV/hematologic complications, while delayed cystectomies have more tissue-healing complications.