Login to Access Video or Poster Abstract: MP54-02
Sources of Funding: None

Introduction

Radical cystectomy (RC) can be a morbid surgery with complication rates as high as 64%. Patients with a history of prior abdominal/pelvic radiation (RT) are thought to be at increased risk for post-operative complications and adverse pathology with RC. Hence, RC may be underutilized in this population. Our objective was to compare post-operative complication rates and pathologic outcomes after RC in patients with prior abdominal/pelvic RT versus those without a RT history.

Methods

An IRB approved retrospective cohort study for patients who underwent RC for urothelial carcinoma (UC) at our institution between 2008-2016 was performed. The cohorts included: any prior abdominal/pelvic RT and no prior RT. Outcomes assessed between cohorts included diversion type, final pathology, length of surgery (ORT) and hospital stay (LOS), blood loss (EBL) and post-operative recovery and complications.

Results

We identified 519 patients who underwent RC for UC during the time period studied. Of these, 56 (11%) patients had a history of abdominal/pelvic RT. All previously radiated patients had received RT for pelvic malignancy, most commonly for prostate cancer (60%). When stratified by prior RT, there were no significant differences in EBL, intra-operative transfusion, and time to bowel function. The overall complication rate in RT patients versus those without prior RT was 48% and 52% respectively (p = 0.74). While there was no statistical difference in fascial dehiscence rate (p = 0.075), there did appear to be a clinically significant difference in rate (25% in those with RT versus 9% in those without RT. Comparisons of pathologic features demonstrated no significant difference between the groups for histology, metastases, margin status, cancer specific and overall survival. However, a significant difference in T-classification was observed, with RT patients being more likely to have pT4 disease (p=0.04).

Conclusions

Although RC remains a surgical procedure with high complication rates, patients with a history of prior abdominal/pelvic RT do not appear to have a higher complication rate and should not be excluded from RC on the basis of prior RT alone. Despite the fact that radiated patients are at greater risk for higher pathologic stage, there were no detectable differences in cancer specific and overall survival. Additional prospective studies are needed to better evaluate this cohort of patients to inform treatment decisions.

Funding

None