Presentation Authors: Jim Shen*, Nora Ruel, Mitchell Bassett, Brian Blair, Alexander Cantrell, Kevin Chan, Clayton Lau, Jonathan Yamzon, Ali Zhumkhawala, Bertram Yuh, Duarte, CA
Introduction: A minority of patients undergoing trimodality therapy for bladder cancer will go on to require salvage cystectomy. We report the outcomes in a small cohort of open and minimally invasive salvage cystectomies with both incontinent and continent urinary diversions.
Methods: From April 1998 to October 2013, 16 cystectomies were performed on patients with a known history of bladder cancer treated with both chemotherapy and radiation therapy. Demographics, pathology, complications, and outcomes data were collected by chart review. The Kaplan-Meier method was used to calculate metastasis-free and overall survival. The log-rank test was used to compare survival curves.
Results: Cystectomy was done for locally recurrent disease in 15 patients and refractory hematuria in one patient. Median age was 75.5 years. Median BMI was 23.6 kg/m2. Median Charlson comorbidity index was 6. 10 of 16 cystectomies were started via a minimally invasive approach (8 robotic, 2 laparoscopic). One robotic and one laparoscopic cystectomy was converted to open. In patients who had lymphadenectomy, median nodal yield was 13 (IQR 6-30). 11 patients had ileal conduit urinary diversion and 5 had continent diversion (4 Indiana pouch, 1 Studer neobladder). Median estimated blood loss was 500 mL and 9 patients required intraoperative blood transfusion. At 90 days after surgery, 5 patients developed a Clavien-Dindo complication grade â‰¥3 (1 mortality). Median hospital stay was 11 days. Five patients developed distant metastasis at a median of 13.3 months after surgery. Median overall survival was 31.4 months (95% CI 4.2-96.8). Patients who had cisplatin-based chemotherapy experienced longer overall survival than those who had non cisplatin-based chemotherapy (67.9 vs. 16.3 months, p=0.03).
Conclusions: Although salvage cystectomy is a morbid surgery, a subset of patients experienced significant metastasis-free and overall survival. Robotic approaches and continent urinary diversions are feasible. Additional study is needed to guide management in this rarely studied patient population.