Paolo Gontero1, Francesca Pisano2,3, Joan Palou4, Steven Joniau5, Maarten Albersen5, Renzo Colombo6, Alberto Briganti6, Federico Pellucchi6, Oscar Rodriguez Faba4, Bas W van Rhijn7, Elies Fransen van de Putte7, Marko Babjuk8, Hanz Martin Fritsche9, Roman Mayr9, Peter Albers10, Gunter Niegisch10, Julien Anract11, Alexandra Masson-Lecomte12, Alexandre De la Taille13, Morgan Roupret14, Benoit Peyronnet14, Tomaso Cai15, Alfred J Witjes16, Max Bruins16, Jack Baniel17, Roy Mano17, Alberto Lapini18, Francesco Sessa18, Jaques Irani19, Maurizio Brausi20, Arnulf Stenzl21, Jeffrey R Karnes22, Douglas Scherr23, Padraic O'Malley23, Benjamin Taylor23, Shahrokh F Shariat24, Peter Black25, Hamidreza Abdi25, Vsevolod B Matveev26, Olga Samuseva26, Dipen Parekh27, Mark Gonzalgo27, Malte W Vetterlein28, Atiqullah Aziz29, Margit Fisch28, James Catto30, Karl H Pang30, Evanguelos Xylinas11, Michael Rink28. 1. Department of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy. 2. Department of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy. francescapisano85@gmail.com. 3. Department of Uro-oncolgy, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. francescapisano85@gmail.com. 4. Department of Uro-oncolgy, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. 5. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Louvain, Belgium. 6. Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 7. Netherland Cancer Institute, Amsterdam, The Netherlands. 8. Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic. 9. Department of Urology, Regensburg University, Regensburg, Germany. 10. Department of Urology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany. 11. Department of Urology, CHU Bichat, Paris, France. 12. Department of Urology, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France. 13. Department of Urology, Henri Mondor Academic Hospital, Creteil, France. 14. Department of Urology, Hôpital La Pitié-Salpétrière, Paris 6 University, Paris, France. 15. Department of Urology, Ospedale S. Chiara, Trento, Italy. 16. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 17. Department of Urology, Rabin Medical Centre, Tel Aviv, Israel. 18. Department of Urology, University of Florence, University Hospital of Florence, Florence, Italy. 19. Department of Urology, Kremlin-Bicetre Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 20. Department of Urology, Ospedale di Carpi-Modena, Modena, Italy. 21. Department of Urology, University Hospital Tübingen, Tübingen, Germany. 22. Department of Urology, Mayo Clinic, Rochester, USA. 23. Department of Urology, Weill Cornell Medical College, New York, USA. 24. Department of Urology, Medical University of Vienna, Vienna, Austria. 25. Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada. 26. Department of Urology, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia. 27. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA. 28. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 29. Department of Urology, University Medical Center Rostock, Rostock, Germany. 30. Academic Urology Unit, University of Sheffield, Sheffield, UK.
Abstract
PURPOSE: Conflicting evidence exists on the complication rates after cystectomy following previous radiation (pRTC) with only a few available series. We aim to assess the complication rate of pRTC for abdominal-pelvic malignancies. METHODS: Patients treated with radical cystectomy following any previous history of RT and with available information on complications for a minimum of 1 year were included. Univariable and multivariable logistic regression models were used to assess the relationship between the variable parameters and the risk of any complication. RESULTS: 682 patients underwent pRTC after a previous RT (80.5% EBRT) for prostate, bladder (BC), gynecological or other cancers in 49.1%, 27.4%, 9.8% and 12.9%, respectively. Overall, 512 (75.1%) had at least one post-surgical complication, classified as Clavien ≥ 3 in 29.6% and Clavien V in 2.9%. At least one surgical complication occurred in 350 (51.3%), including bowel leakage in 6.2% and ureteric stricture in 9.4%. A medical complication was observed in 359 (52.6%) patients, with UTI/pyelonephritis being the most common (19%), followed by renal failure (12%). The majority of patients (86%) received an incontinent urinary diversion. In multivariable analysis adjusted for age, gender and type of RT, patients treated with RT for bladder cancer had a 1.7 times increased relative risk of experiencing any complication after RC compared to those with RT for prostate cancer (p = 0.023). The type of diversion (continent vs non-continent) did not influence the risk of complications. CONCLUSION: pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.
PURPOSE: Conflicting evidence exists on the complication rates after cystectomy following previous radiation (pRTC) with only a few available series. We aim to assess the complication rate of pRTC for abdominal-pelvic malignancies. METHODS:Patients treated with radical cystectomy following any previous history of RT and with available information on complications for a minimum of 1 year were included. Univariable and multivariable logistic regression models were used to assess the relationship between the variable parameters and the risk of any complication. RESULTS: 682 patients underwent pRTC after a previous RT (80.5% EBRT) for prostate, bladder (BC), gynecological or other cancers in 49.1%, 27.4%, 9.8% and 12.9%, respectively. Overall, 512 (75.1%) had at least one post-surgical complication, classified as Clavien ≥ 3 in 29.6% and Clavien V in 2.9%. At least one surgical complication occurred in 350 (51.3%), including bowel leakage in 6.2% and ureteric stricture in 9.4%. A medical complication was observed in 359 (52.6%) patients, with UTI/pyelonephritis being the most common (19%), followed by renal failure (12%). The majority of patients (86%) received an incontinent urinary diversion. In multivariable analysis adjusted for age, gender and type of RT, patients treated with RT for bladder cancer had a 1.7 times increased relative risk of experiencing any complication after RC compared to those with RT for prostate cancer (p = 0.023). The type of diversion (continent vs non-continent) did not influence the risk of complications. CONCLUSION: pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.
Authors: James Robert Janopaul-Naylor; Jim Zhong; Yuan Liu; Chao Zhang; Adeboye O Osunkoya; Shreyas Subhash Joshi; Mehmet Asim Bilen; Bradley Carthon; Omer Kucuk; Lindsey Marie Hartsell; Joseph Shelton; Ashesh B Jani Journal: Clin Transl Radiat Oncol Date: 2020-11-09
Authors: Liesbeth Demaegd; Maarten Albersen; Tim Muilwijk; Uros Milenkovic; Lisa Moris; Wouter Everaerts; Hendrik Van Poppel; Frank Van der Aa; Steven Joniau; Murat Akand Journal: Transl Androl Urol Date: 2020-12
Authors: Victor M Schuettfort; Benjamin Pradere; Fahad Quhal; Hadi Mostafaei; Ekaterina Laukhtina; Keiichiro Mori; Reza Sari Motlagh; Margit Fisch; David D'Andrea; Michael Rink; Paolo Gontero; Francesco Soria; Shahrokh F Shariat Journal: World J Urol Date: 2020-09-29 Impact factor: 4.226