Salvage cystectomy after irradiation failure

Area of Science:

• Urology
• Oncology

Background:

• Invasive bladder cancer often necessitates radical treatments.
• Preoperative irradiation followed by cystectomy is superior to monotherapy.
• A subset of patients unsuitable for neoadjuvant therapy receive definitive irradiation, with high failure rates.

Purpose of the Study:

• To review the outcomes of salvage cystectomy in patients who failed definitive irradiation therapy for invasive bladder cancer.
• To analyze patient selection, morbidity, mortality, and survival rates associated with salvage cystectomy.

Main Methods:

• Retrospective review of 37 consecutive patients undergoing salvage cystectomy after failed definitive irradiation therapy.
• Analysis of operative selection, complication rates, mortality, and survival based on pathological stage and surgical approach.

Main Results:

• The overall mortality rate was 8.1% and early complication rate was 24%.
• Patients undergoing a 2-stage procedure or early perineal approach had no mortality and reduced complications.
• Overall survival was 38%, with significantly better survival (63%) for pathological stage O or A disease compared to stage B or greater (19%).

Conclusions:

• Salvage cystectomy is a viable option for patients with invasive bladder cancer who fail definitive irradiation.
• Early salvage cystectomy after irradiation failure is recommended.
• Selective use of staged procedures and perineal approach can decrease morbidity and mortality.