Salvage cystectomy post-trimodality therapy tied to late complications

Salvage cystectomy following trimodality therapy for intravesical recurrence demonstrates similar intraoperative and early complication rate to primary cystectomy and primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy, reports a study.

Additionally, salvage cystectomy after trimodality therapy leads to greater overall and major late complications compared to primary cystectomy, but both groups have similar disease-specific and overall survival among those requiring salvage cystectomy post-trimodality therapy.

Two hundred sixty-five patients who underwent radical cystectomy at Massachusetts General Hospital for cT1-T4 bladder cancer between 2003 and 2013 were included in this study. Patients were grouped as follows: salvage cystectomy post-trimodality therapy, primary cystectomy, or primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy.

The investigators then compared early (≤90 days) and late (>90 days) complications between groups. They then calculated disease-specific and overall survival using a Cox regression model and generated adjusted survival curves.

Over a median follow-up of 65.5 months from the time of cystectomy, no difference was noted in intraoperative and early complications between the groups. However, late complications were higher in salvage cystectomy post-trimodality therapy than in primary cystectomy and primary cystectomy with prior history of nontrimodality therapy abdominal or pelvic radiotherapy (p=0.03).

Multivariable Cox regression analysis revealed the association of salvage cystectomy post-trimodality therapy with a higher incidence of any late (hazard ratio [HR], 2.3; p=0.02) and major late complications (HR, 2.1; p<0.05). Of note, no between-group difference was seen in disease-specific (p=0.8) or overall survival (p=0.9).