title: Urinary diversion-related outcome in patients with pelvic recurrence after radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  To evaluate the impact of urinary diversion on disease status, complications, and subsequent treatment in patients with pelvic tumor recurrence after radical cystectomy for bladder cancer.
  
  
  METHODS
  A retrospective review of 201 consecutive cases of radical cystectomy for bladder cancer, performed at our institution between March 1991 and March 1996, identified 33 patients (16.4%) with disease recurrence in the pelvis with or without systemic metastasis. Urinary diversion in patients with tumor recurrence was an ileal conduit, continent cutaneous diversion, or orthotopic neobladder in 19, 3, and 11 patients, respectively. The mean follow-up for all patients undergoing cystectomy was 25.9 months (range 8 to 75). The mean time to diagnosis of local disease recurrence after cystectomy was 13.9 months (range 5 to 50).
  
  
  RESULTS
  In 21 (63.6%) of 33 patients, pelvic recurrence and systemic metastasis were present simultaneously. Disease recurrence was associated with poor outcome: only 8 patients (24.2%) were alive and disease free, 7 of whom had isolated local recurrence without evidence of systemic metastasis. There was no difference in overall survival or type of therapy delivered once disease recurrence was diagnosed between patients with an orthotopic neobladder and those with a cutaneous (continent or incontinent) urinary diversion. The only diversion-related complication resulting from pelvic recurrence was 1 case of tumor invasion into an orthotopic neobladder, requiring conversion to an ileal conduit.
  
  
  CONCLUSIONS
  The type of urinary diversion did not impact a patient's risk of complications, the ability to receive salvage treatment, or overall survival once pelvic recurrence was diagnosed. Patients at high risk of pelvic recurrence should not be excluded from receiving an orthotopic urinary diversion.
authors.affiliation: Department of Urology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute, Detroit, Michigan 48201, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Tefilli
authors.forename: E L
authors.initials: EL
authors.lastname: Gheiler
authors.forename: R
authors.initials: R
authors.lastname: Tiguert
authors.forename: D J
authors.initials: DJ
authors.lastname: Grignon
authors.forename: J D
authors.initials: JD
authors.lastname: Forman
authors.forename: J E
authors.initials: JE
authors.lastname: Pontes
authors.forename: D P
authors.initials: DP
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion