The case for salvage cystectomy after pelvic radiation

Radical cystectomy is considered the standard of care for muscle invasive bladder cancer (MIBC), as well as some high-grade or recurrent non-muscle invasive bladder cancers. There are a number of reasons that urologic surgeons may find themselves considering a salvage cystectomy (SC) for a patient. Understanding the risks associated with performing SC is important for patient counseling when considering primary management of MIBC. Awareness of the unique complications that can occur can alter surgical technique and approach and can equip clinical staff with knowledge to properly monitor the patient during post-operative surveillance to identify and treat these situations. In this review, we characterize the outcomes of patients who underwent SC, elucidate the special considerations that must be made when performing this surgery, and discuss these outcomes in comparison to primary surgery in the absence of radiation.