Introduction

Patients with advanced bladder cancer may receive radical cystectomy (RC) or Trimodal therapy (TMT) as treatment. After TMT, failure to respond to induction therapy or recurrence may be followed by salvage RC. We compare the timing and nature of complications, and overall survival between these two procedures at our institution.

Methods

We retrospectively identified patients from our contemporary cohort spanning from 2002 to 2013 that underwent primary RC and 22 patients that underwent TMT followed by salvage RC for disease progression. Patients were limited to those with a diagnosis of bladder cancer without radiographic evidence of lymph node or distant metastasis. Early (≤90 day) complication rates were compared using Fisher&[prime]s exact test. Overall survival and late (>90 day) complications were compared using Kaplan Meier curves, and the log-rank test.

Results

From 2003 to 2013 we identified 239 patients who underwent primary RC and 22 patients who underwent salvage RC. The median age of the cohort was 68, 76% were male and the median follow-up was 5 years. The groups had similar baseline characteristics, except that those that underwent salvage RC had higher rates of tobacco use (95% vs 68%, p=0.006), and were less likely have a neobladder (4.6% vs 8.8%, p=0.03). 43 patients (17%) that underwent primary cystectomy received neoadjuvant chemotherapy. _x000D_ _x000D_ There were no significant differences between salvage RC and primary RC in terms of overall survival (log-rank P=0.8) or disease specific survival (P=0.7). _x000D_ _x000D_ The overall early complication rate was 77% after salvage RC compared to 57% after primary RC (p=0.07). Early infectious complications were significantly higher after salvage (36% vs 11%, p=0.002). _x000D_ _x000D_ The 1-, 3-, and 5-yr overall late complications rate after salvage RC was 8.3%, 36%, and 68% compared to 5.8%, 14%, and 16% after primary RC (log-rank p=0.033, Figure 1), respectively. _x000D_ After salvage, there was an increased rate of late infectious (23% vs 7.5, p=0.03) and late gastrointestinal (27% vs 4.0%, p=<0.001) complications. _x000D_

Conclusions

The overall survival, disease specific survival, and overall early complication rates are comparable between primary cystectomy and salvage cystectomy after TMT. _x000D_

Funding

none