Radical cystectomy for recurrent urothelial carcinoma after prior partial cystectomy: perioperative and oncologic outcomes

Ross J. Mason, Igor Frank, Bimal Bhindi, Matthew K. Tollefson, R. Houston Thompson, Robert Jeffrey Karnes, Robert Tarrell, Prabin Thapa, Stephen A. Boorjian

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate perioperative and oncologic outcomes of patients undergoing radical cystectomy (RC) for recurrence of urothelial carcinoma (UC) after prior partial cystectomy (PC), and to compare these outcomes to patients undergoing primary RC. Methods: Patients who underwent RC for recurrence of UC after prior PC were matched 1:3 to patients undergoing primary RC based on age, pathologic stage, and decade of surgery. Perioperative and oncologic outcomes were compared using Wilcoxon sign-rank test, McNemars test, the Kaplan–Meier method, and Cox proportional hazards regression analyses. Results: Overall, the cohorts were well matched on clinical and pathological characteristics. No difference was noted in operative time (median 322 versus 303 min; p = 0.41), estimated blood loss (median 800 versus 700 cc, p = 0.10) or length of stay (median 9 versus 10 days; p = 0.09). Similarly, there were no differences in minor (51.7 versus 44.3%; p = 0.32) or major (10.3 versus 12.6%; p = 0.66) perioperative complications. Median follow-up after RC was 5.0 years (IQR 1.5, 13.1 years). Notably, CSS was significantly worse for patients who underwent RC after PC (10 year—46.8 versus 65.9%; p = 0.03). On multivariable analysis, prior PC remained independently associated with an increased risk of bladder cancer death (HR 2.28; 95% CI 1.17, 4.42). Conclusions: RC after PC is feasible, without significantly adverse perioperative outcomes compared to patients undergoing primary RC. However, the risk of death from bladder cancer may be higher, suggesting the need for careful patient counseling prior to PC and the consideration of such patients for adjuvant therapy after RC.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Sep 14 2017

Keywords

  • Outcomes
  • Partial cystectomy
  • Radical cystectomy
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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    Mason, R. J., Frank, I., Bhindi, B., Tollefson, M. K., Thompson, R. H., Karnes, R. J., Tarrell, R., Thapa, P., & Boorjian, S. A. (Accepted/In press). Radical cystectomy for recurrent urothelial carcinoma after prior partial cystectomy: perioperative and oncologic outcomes. World Journal of Urology, 1-6. https://doi.org/10.1007/s00345-017-2087-4