Differential Complication Rates Following Radical Cystectomy in the Irradiated and Nonirradiated Pelvis

Background: Reports suggest that cystectomy following pelvic irradiation is associated with a higher morbidity and mortality than in primary cases. However, such reports are from an era when postcystectomy complication rates were higher than are currently reported. Objective: This study evaluates perioperative complications and mortality in primary radical and postradiation salvage cystectomy. Design, setting, and participants: Patients treated with cystectomy for bladder cancer or advanced pelvic malignancies involving the bladder were studied. Measurements: Perioperative complications and mortality were analysed for 426 primary and 420 salvage cystectomies performed at a single institution between 1970 and 2005. Results and limitations: The 30- and 60-d mortality in the 2000-2005 cohort were 0% and 1.2%, respectively, in the primary group and 1.4% and 4.3%, respectively, in the salvage cystectomy group. Thirty-day mortality between 1970 and 2005 was not statistically significant in the primary and salvage groups (4.2% and 7.1%, respectively). Conclusions: This large series from a high-volume centre demonstrates no difference in perioperative mortality in primary or postradiation salvage radical cystectomy. Similarly, there was no significant difference in the incidence of most of the surgical or medical complications in either group, although the stomal stenosis rate was higher postradiation. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.