J. L. Pfail1, A. Kaldany1, B. Lichtbroun1, R. Passarelli1, H. Patel1, A. Srivastava1, D. Golombos1, T. L. Jang1, K. Chua1, S. Ghodoussipour1 1Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Section Of Urologic Oncology, New Brunswick, NJ, USA
Introduction: Radical cystectomy (RC) is a standard of care treatment option for patients with muscle invasive bladder cancer (MIBC) and the recommended option in patients with history of prior radiation therapy. Understanding complication rates of RC after prior radiation is important when counseling patients regarding initial treatment options for MIBC. We aim to report complications in this patient population and to assess if prior pelvic radiation is associated with an increased risk of postoperative complications.
Methods: The National Surgical Quality Improvement Program database included 4,351 patients undergoing RC from 2019 to 2021. Baseline characteristics and complication rates were stratified by history of prior pelvic radiation. Statistical endpoints included thirty-day complications, length of stay (LOS), readmissions, and mortality. Univariable and multivariable analyses were performed to determine factors associated with postoperative morbidity. Factors included in the multivariable analysis included those that were clinically relevant or had a p-value less than 0.05 on univariable analysis.
Results: A total of 356 (8.18%) patients undergoing RC received prior pelvic radiation. Compared to patients without prior radiation history, irradiated patients were older (median age: 73 v. 70), had a higher American Society of Anesthesiologists (ASA) classification (84.8% v. 78% patients with ASA ≥3), and higher rates of hypertension (65.2% v. 58.8%). Furthermore, irradiated patients were less likely to receive a continent diversion (6.18% v. 14.4%). Patients with radiation history were noted to experience higher rates of any complication (52.2% v. 42.6%), wound complications (16.9% v. 11.8%), longer LOS (median [IQR], 6 days [5-8.25] v. 6 [5-8]), higher readmission rates (26.1% v. 20.6%), and increased 30-day mortality rates (3.09% v. 1.5%). After controlling for potential confounding factors with multivariable analyses, history of prior pelvic radiation was associated with increased rates of any complication (OR:1.37; 95% CI 1.1-1.71), wound complications (OR:1.43; 95% CI 1.05-1.93), other complications (OR:1.48; 95% CI 1.02-2.14), increased LOS (β:0.5; 95% CI 0.07-0.92), and increased 30-day readmission (OR:1.32; 95% CI 1.02-1.7) (all p<0.05) (Table 1).
Conclusion: A history of prior pelvic radiation in patients undergoing RC was associated with an increased risk of postoperative complications and readmission rates. Specifically, there was an increased risk of wound complications. This analysis gives insight on the complication risks of salvage cystectomy, and these complications should be considered when counseling patients regarding treatment options for MIBC.
