SHORT-TERM OUTCOMES IN RADICAL CYSTECTOMY PATIENTS WITH HISTORY OF PRIOR PELVIC RADIATION
Ikenna Madueke, MD. Ph.D.1, Mark Preston, MD, MPH2, Timothy Clinton, MD2, Graeme Steele, MD2, Steven Chang, MD, MS2, Adam Kibel, MD2, Matthew Mossanen, MD2.
1Harvard Medical School, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND:Radical cystectomy (RC) remains the standard of care for muscle-invasive bladder cancer as well as subsets of non-muscle invasive bladder cancer. Radiation to the pelvis for malignancy treatment may predispose patients who later need RC for bladder cancer to worse outcomes. Recently, there has been conflicting data on this topic. We thus sought to investigate the short-term outcomes in RC patients with a history of prior pelvic radiation in our cohort.
METHODS:After obtaining IRB approval, we retrospectively reviewed patients with bladder cancer undergoing RC at our institution compared to those with bladder cancer and history prior pelvic radiation also undergoing RC. Pearson Chi Square test was used to assess categorical variables. Wilcoxon rank sum-test was used to assess continuous variables. Linear or binary logistic regression was used to calculate odds ratios listed as point estimates as well as 95% confidence intervals. Kaplan-Meier method with stratified-log rank was used to compare time-to-event.
RESULTS:342 patients met inclusion criteria from 2018 through 2021. 47 (13.7%) received prior prostate radiation. The prior radiation group had longer median length of primary stay compared to RC at 8.0 days and 6.0 days respectively (p=0.012). The radiation group also had more overall complications at 53.2% compared to 35.9% for the RC group (p=0.024). There was no significant difference between the groups in operative time, estimated blood loss, 30-day re-admission or 30-day mortality.
CONCLUSIONS:Patients undergoing RC with prior pelvic radiation are at higher risk of overall complications and longer length of stay in the hospital. Patients should thus be counseled accordingly. Longer follow-up will elucidate if this translates to worse overall survival.
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