Complications of cystectomy in patients with a history of pelvic radiation.
OBJECTIVE
To compare the complications occurring during the first year of follow-up after radical cystectomy in two groups, one with and one without a history of pelvic radiation. Radical cystectomy and urinary diversion is the treatment of choice for invasive bladder cancer.


METHODS
One hundred ninety-four cystectomies were performed between January 1995 and June 2000 by a single surgeon. Twenty-three patients were identified with a history of external beam radiotherapy to the pelvis (EBRT group), and 23 additional patients without a history of pelvic radiation were randomly selected to serve as the control group.


RESULTS
Although the overall risk of having a complication was not statistically different in the EBRT group (48%) than in the control group (30%; P = 0.183), complications directly related to surgery were higher in the EBRT group than in the control group (48% versus 26%; P = 0.045). The patients in the EBRT group were more likely to require an invasive procedure (39% versus 9%; P = 0.018). In addition, 5 (22%) of 23 patients in the EBRT group had a symptomatic fluid collection, which was diagnosed as a urine leak (n = 2) or an abdominal abscess (n = 3). In contrast, no patient in the control group developed a symptomatic fluid collection.


CONCLUSIONS
Cystectomy after pelvic radiation is associated with acceptable morbidity; however, compared with cystectomy performed in a nonirradiated pelvis, the risk of complications that will require invasive intervention is increased. A history of prior pelvic radiation significantly increases the risk of a symptomatic fluid collection.
Kim
H L
HL
Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Steinberg
G D
GD
D000368:Aged; D015897:Comorbidity; D015653:Cystectomy / Q000009:adverse effects*; D005205:Fascia / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D007511:Ischemia / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011827:Radiation; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology* / Q000473:pathology; D014513:Ureter / Q000098:blood supply / Q000473:pathology; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000453:epidemiology*; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D014547:Urinary Diversion; D014565:Urogenital Neoplasms / Q000532:radiotherapy* / Q000601:surgery