Complication rate after cystectomy following pelvic radiotherapy: an international, multicenter, retrospective series of 682 cases
Por:
Gontero, P, Pisano, F, Palou, J, Joniau, S, Albersen, M, Colombo, R, Briganti, A, Pellucchi, F, Faba, OR, van Rhijn, BW, van de Putte, EF, Babjuk, M, Fritsche, HM, Mayr, R, Albers, P, Niegisch, G, Anract, J, Masson-Lecomte, A, De la Taille, A, Roupret, M, Peyronnet, B, Cai, T, Witjes, AJ, Bruins, M, Baniel, J, Mano, R, Lapini, A, Sessa, F, Irani, J, Brausi, M, Stenzl, A, Karnes, JR, Scherr, D, O'Malley, P, Taylor, B, Shariat, SF, Black, P, Abdi, H, Matveev, VB, Samuseva, O, Parekh, D, Gonzalgo, M, Vetterlein, MW, Aziz, A, Fisch, M, Catto, J, Pang, KH, Xylinas, E, Rink, M, Young Acad Urologists Urothel
Publicada:
1 ago 2020
Ahead of Print:
1 nov 2019
Resumen:
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-naive RCs.
Filiaciones:
Gontero, P:
Univ Torino, Sch Med, Molinette Hosp, Dept Urol, Turin, Italy
Pisano, F:
Univ Torino, Sch Med, Molinette Hosp, Dept Urol, Turin, Italy
Univ Barcelona, Fundacio Puigvert, Dept Urooncolgy, Barcelona, Spain
Palou, J:
Univ Barcelona, Fundacio Puigvert, Dept Urooncolgy, Barcelona, Spain
Joniau, S:
Univ Hosp Leuven, Dept Urol, Oncol & Reconstruct Urol, Louvain, Belgium
Albersen, M:
Univ Hosp Leuven, Dept Urol, Oncol & Reconstruct Urol, Louvain, Belgium
Colombo, R:
Osped San Raffaele, IRCCS, URI, Unit Urol,Div Oncol, Milan, Italy
Briganti, A:
Osped San Raffaele, IRCCS, URI, Unit Urol,Div Oncol, Milan, Italy
Pellucchi, F:
Osped San Raffaele, IRCCS, URI, Unit Urol,Div Oncol, Milan, Italy
Faba, OR:
Univ Barcelona, Fundacio Puigvert, Dept Urooncolgy, Barcelona, Spain
van Rhijn, BW:
Netherland Canc Inst, Amsterdam, Netherlands
van de Putte, EF:
Netherland Canc Inst, Amsterdam, Netherlands
Babjuk, M:
Univ Praha, Motol Hosp, Dept Urol, Prague, Czech Republic
Fritsche, HM:
Regensburg Univ, Dept Urol, Regensburg, Germany
Mayr, R:
Regensburg Univ, Dept Urol, Regensburg, Germany
Albers, P:
Heinrich Heine Univ, Dept Urol, Med Fac, Dusseldorf, Germany
Niegisch, G:
Heinrich Heine Univ, Dept Urol, Med Fac, Dusseldorf, Germany
Anract, J:
CHU Bichat, Dept Urol, Paris, France
Masson-Lecomte, A:
Univ Paris Diderot, Hop St Louis, Dept Urol, Paris, France
De la Taille, A:
Henri Mondor Acad Hosp, Dept Urol, Creteil, France
Roupret, M:
Paris 6 Univ, Hop La Pitie Salpetriere, Dept Urol, Paris, France
Peyronnet, B:
Paris 6 Univ, Hop La Pitie Salpetriere, Dept Urol, Paris, France
Cai, T:
Osped S Chiara, Dept Urol, Trento, Italy
Witjes, AJ:
Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands
Bruins, M:
Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands
Baniel, J:
Rabin Med Ctr, Dept Urol, Tel Aviv, Israel
Mano, R:
Rabin Med Ctr, Dept Urol, Tel Aviv, Israel
Lapini, A:
Univ Florence, Univ Hosp Florence, Dept Urol, Florence, Italy
Sessa, F:
Univ Florence, Univ Hosp Florence, Dept Urol, Florence, Italy
Irani, J:
Kremlin Bicetre Hosp, AP HP, Dept Urol, Paris, France
Brausi, M:
Osped Carpi Modena, Dept Urol, Modena, Italy
Stenzl, A:
Univ Hosp Tubingen, Dept Urol, Tubingen, Germany
Karnes, JR:
Mayo Clin, Dept Urol, Rochester, MN USA
Scherr, D:
Weill Cornell Med Coll, Dept Urol, New York, NY USA
O'Malley, P:
Weill Cornell Med Coll, Dept Urol, New York, NY USA
Taylor, B:
Weill Cornell Med Coll, Dept Urol, New York, NY USA
Shariat, SF:
Med Univ Vienna, Dept Urol, Vienna, Austria
Black, P:
Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
Abdi, H:
Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
Matveev, VB:
NN Blokhin Russian Canc Res Ctr, Dept Urol, Moscow, Russia
Samuseva, O:
NN Blokhin Russian Canc Res Ctr, Dept Urol, Moscow, Russia
Parekh, D:
Univ Miami, Miller Sch Med, Dept Urol, Miami, FL 33136 USA
Gonzalgo, M:
Univ Miami, Miller Sch Med, Dept Urol, Miami, FL 33136 USA
Vetterlein, MW:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Aziz, A:
Univ Med Ctr Rostock, Dept Urol, Rostock, Germany
Fisch, M:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Catto, J:
Univ Sheffield, Acad Urol Unit, Sheffield, S Yorkshire, England
Pang, KH:
Univ Sheffield, Acad Urol Unit, Sheffield, S Yorkshire, England
Xylinas, E:
CHU Bichat, Dept Urol, Paris, France
Rink, M:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
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