Login to Access Video or Poster Abstract: MP21-06
Sources of Funding: None

Introduction

While partial cystectomy (PC) represents an option for select patients with urothelial carcinoma (UC), approximately 20% of patients treated with PC have been reported to ultimately require radical cystectomy (RC) for disease recurrence. The outcomes for these patients have not been well described to date. We therefore evaluated perioperative and oncologic outcomes of patients undergoing RC after PC for UC.

Methods

We identified 61 patients who underwent RC at our institution after prior PC for UC between 1980-2010. These patients were then matched 1:3 to patients undergoing primary RC based on age, pathologic T and N stage, and decade of surgery. Perioperative outcomes were compared between the two groups using descriptive statistics. Cancer-specific (CSS) and overall survival (OS) were evaluated using the Kaplan-Meier method and conditional Cox proportional hazards regression models.

Results

Median age at the time of RC was 67 yrs in both groups (IQR 62, 75), while 47/61 (77%) RC after PC and 151/181 (83.4%) primary RC patients were male. Median time from PC to RC was 1.5 years (IQR 0.6, 4.4). Median Charlson comorbidity index was 2 for both groups (IQR 2, 8). Estimated blood loss was significantly higher among patients undergoing RC after PC compared to primary RC (median 1000 cc vs 700 cc; p=0.001), although there was no difference in operative time (median 322 min vs 292 min; p=0.17) or length of stay (median 10 vs 11 days; p=0.27). Similarly, there was no difference in either minor (Clavien 1-2) (49.2% vs 44.8%; p=0.71) or major (Clavien 3-5) (9.8% vs 8.3%; p=0.55) perioperative complications between the RC after PC and the RC alone groups. Median follow-up after RC was 6.0 years (IQR 1.5, 15.6), during which time 204 patients died, including 95 who died of UC. Five-year CSS was significantly worse for patients who underwent RC after PC versus primary RC (58% vs 67%; p=0.02; HR 1.8; 95% CI 1.1, 3.0), while no significant difference in 5-year OS was noted (51% vs 54%; p=0.42; HR 1.2; 95% CI 0.8, 1.7).

Conclusions

Patients who underwent RC for recurrent UC after prior PC had similar perioperative outcomes to stage-matched patients undergoing primary RC. However, such patients were noted to be at a higher risk of subsequently dying from bladder cancer. These data may be used in counseling patients considering PC as initial treatment for invasive UC, as well as for consideration of adjuvant therapy after RC following PC.

Funding

None