Salvage Cystectomy
Review of 19 Cases

Lindell, O

doi:10.1159/000472729

Cited by 12 publications

(3 citation statements)

References 12 publications

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“…Survival in the present series was in agreement with previously reported 5‐year survivals, but long‐term survival rates vary widely, at 5–45%[9–13]. In general, tumour category is an important factor affecting survival.…”

Section: Discussionsupporting

confidence: 92%

Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer

Nieuwenhuijzen¹,

Horenblas²,

Meinhardt³

et al. 2004

BJU International

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OBJECTIVE To evaluate the long‐term results of salvage cystectomy after interstitial radiotherapy (IRT) and external beam radiotherapy (EBRT) for transitional cell carcinoma, and to assess the morbidity and functional results of the different urinary diversions used. PATIENTS AND METHODS The records of 27 patients treated with salvage cystectomy in one institution between 1988 and 2003 were retrospectively analysed. RESULTS Salvage cystectomy was used after failure of IRT in 14 or EBRT in 13 patients, with a 3‐ and 5‐year survival probability of 46% (95% confidence interval 26–65) and 33 (11–54)%. The 5‐year overall survival after cystectomy was 54% after IRT and 14% after EBRT (P = 0.12). Tumour category, response to radiation, American Society of Anesthesiology score, and complete tumour resection had a significant influence on survival. Five of seven patients with incomplete resection died because of local disease, with a median survival of 5 months. There was clinical understaging after radiotherapy in 41% of patients. Nine patients had an orthotopic neobladder, with complete day‐ and night‐time continence in eight and four, respectively. All patients but one had good voiding function. There were early complications in two and late complications in six patients (for Bricker, seven of 14 and none; for Indiana, none of four and two of four). The duration of hospitalization was not influenced by the type of diversion. Erectile function was maintained in four of six patients after a sexuality‐preserving cystectomy and neobladder. CONCLUSIONS Salvage cystectomy can be performed with acceptable morbidity using any type of urinary diversion. Understaging after radiotherapy is common, but preoperative selection needs improving. A very significant factor for an adverse outcome and death from local tumour recurrence was incomplete resection, suggesting that salvage cystectomy should only be attempted if complete resection is probable.

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Section: Discussionsupporting

confidence: 92%

Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer

Nieuwenhuijzen¹,

Horenblas²,

Meinhardt³

et al. 2004

BJU International

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“…The risk of complications depends on the doses of radiation given. Highdose (>60 Gy) pelvic irradiation is likely to increase both mortality and morbidity of RC; in patients undergoing RC after definitive radiotherapy (>60 Gy), mortality rates range from 6% to 33%, 11,58,59 higher than the rates reported in published contemporary RC series for non-irradiated subjects, which range up to 4%. [60][61][62][63][64][65] Reportedly, intermediatedose (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) Gy) pelvic irradiation does not significantly increase mortality, but does increase morbidity associated with stomal stenosis.…”

Section: Increased Mortality and Morbidity Of Salvage Rcmentioning

confidence: 88%

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Koga

Kihara

2012

Int J of Urology

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Abbreviations & Acronyms BIS = bladder-intact survival CIS = carcinoma in situ CR = complete response CRT = chemoradiotherapy CSS = cancer-specific survival FU = fluorouracil GasLESS = gasless laparoendoscopic single-port surgery GC = gemcitabine, cisplatin HD = hemodialysis IAC = intra-arterial chemotherapy IMRT = intensity-modulated radiation therapy LCRT = low-dose chemoradiotherapy MCV = methotrexate, cisplatin and vinblastine MIBC = muscle-invasive bladder cancer MRI = magnetic resonance imaging MVAC = methotrexate, vinblastine, adriamycin and cisplatin NA = not available NFkB = nuclear factor kB NMIBC = non-muscle-invasive bladder cancer OS = overall survival PC = partial cystectomy PLND = pelvic lymph node dissection QoL = quality of life RC = radical cystectomy RTOC = Radiation Therapy Oncology Group SPARE = Selective bladder Preservation Against Radical Excision TMDU = Tokyo Medical and Dental University TURBT = transurethral resection of bladder tumors Abstract: Radical cystectomy plus urinary diversion, the reference standard treatment for muscle-invasive bladder cancer, associates with high complication rates and compromises quality of life as a result of long-term effects on urinary, gastrointestinal and sexual function, and changes in body image. As a society ages, the number of elderly patients unfit for radical cystectomy as a result of comorbidity will increase, and thus the demand for bladder-sparing approaches for muscle-invasive bladder cancer will also inevitably increase. Trimodality bladder-sparing approaches consisting of transurethral resection, chemotherapy and radiotherapy (S55-65 Gy) yield overall survival rates comparable with those of radical cystectomy series (50-70% at 5 years), while preserving the native bladder in 40-60% of muscle-invasive bladder cancer patients, contributing to an improvement in quality of life for such patients. Limitations of the trimodality therapy include (i) muscle-invasive bladder cancer recurrence in the preserved bladder, which most often arises in the original muscle-invasive bladder cancer site; (ii) potential lack of curative intervention for regional lymph nodes; and (iii) increased morbidity in the event of salvage radical cystectomy for remaining or recurrent disease as a result of high-dose pelvic irradiation. Consolidative partial cystectomy with pelvic lymph node dissection followed by induction chemoradiotherapy at lower dose (e.g. 40 Gy) is a rational strategy for overcoming such limitations by strengthening locoregional control and reducing radiation dosage. Molecular profiling of the tumor and functional imaging might play important roles in optimal patient selection for bladder preservation. Refinement of radiation techniques, intensified concurrent or adjuvant chemotherapy, and novel sensitizers, including molecular targeting agent, are also expected to improve outcomes and consequently provide more muscle-invasive bladder cancer patients with favorable quality of life.

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“…Most of the retrieved studies reporting survival rates after SRC referred to cystectomy performed after preserving bladder treatment for MIBC [Table 1] [5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Moreover, there are no completed randomized trials comparing the oncological outcomes of preserving bladder treatment with RC [2] , whereby the current oncological benefit of SRC after a bladder preserving treatment is based mainly on surgical series.…”

Section: Salvage Radical Cystectomy After Trimodal Therapy: Oncological Outcomesmentioning

confidence: 99%

An investigative review on the current role and outcomes of salvage radical cystectomy

Cicione¹,

Lombardo²,

Voglino³

et al. 2021

MIS

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Salvage radical cystectomy (SRC) is currently performed after failure of a trimodal treatment (TMT) for muscle invasive bladder cancer (MIBC) and also as a palliative surgery to manage bladder cancer-related symptoms. We reviewed the available literature to assess the current outcomes of SRC. A comprehensive research of the Medline and Embase databases was carried out by following the Preferred Items for Systematic Reviews and Meta-Analysis. Bladder cancer, radiotherapy, salvage, and cystectomy were the main keywords used in the research. Due to the lack of studies, no time restriction was applied, however only English language and only studies using Clavien-Dindo Grade (CCS) to report complications were considered. Overall, 285 studies were identified, of which 41 studies were considered eligible for the purpose of this review. No comparative studies were found between TMT plus SRC and immediate radical cystectomy. Thirteen studies reported oncological outcomes after TMT. The five-year mean disease free survival rate of patients who underwent SRC after TMT was reported to be about 50% and the 5-year OS rate was between 33% and 48%. Three studies including fewer than 20 patients performed SRC with palliative purpose. Although no perioperative death occurred, patients were highly selected. Overall, 4 studies graded surgery-related complications by CCS. The rate of major complications, defined as CCS ≥ 3, was reported to be between 16% and 32%, most of them being gastrointestinal complications. SRC still preserves a role in the management of MIBC, being part of TMT and palliative care in highly selected patients. However, this surgery is at higher risk of complications and is associated with incontinent urinary diversion, thus an accurate discussion during patient counseling is advisable.

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Salvage Cystectomy Review of 19 Cases

Cited by 12 publications

References 12 publications

Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer

Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

An investigative review on the current role and outcomes of salvage radical cystectomy

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