title: The safety of robot-assisted cystectomy in patients with previous history of pelvic irradiation.
abstract: To determine the safety of robot-assisted cystectomy (RAC) in patients with an irradiated pelvis, by comparing perioperative complication outcomes after RAC in patients with and without a history of pelvic irradiation.
  
  
  
  In all, 252 consecutive patients underwent RAC at a tertiary referral centre from 2002 to 2013. Of all patients, 46 (18%) had a history of pelvic irradiation. Complications occurring at ≤30 days and ≤90 days of RAC were graded using the modified Clavien-Dindo classification system and additionally categorised by organ system. Baseline variables and outcomes of irradiated and non-irradiated patients were compared using descriptive statistics. Multivariable logistic regression models were generated to test the effect of previous pelvic irradiation on complications.
  
  
  
  The indications for RAC in patients with a history of pelvic irradiation were: bladder cancer (30 patients, 65%), prostate cancer (two, 4%), fistulae (five, 11%), and intractable symptoms from radiation cystitis (nine, 20%). In all, 25 (54%) irradiated and 112 (54%) non-irradiated patients had complications at ≤90 days (P > 0.9), of which 11 (24%) and 43 (21%) respectively had major complications (P = 0.7). One (2%) patient with and two (1%) patients without a history of irradiation died from surgical complications (P = 0.5). Infectious, bleeding, and gastrointestinal complications were the most common events in both groups. In multivariable analyses, a history of pelvic irradiation was not associated with a higher risk of complications.
  
  
  
  RAC performed by an experienced surgeon is a reasonable option in selected patients with a history of pelvic irradiation, as complication rates do not significantly differ compared with non-irradiated patients.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Bashir
authors.initials: B
authors.lastname: Al Hussein Al Awamlh
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.|Bern University Hospital, Bern, Switzerland.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nguyen
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Otto
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Padraic
authors.initials: P
authors.lastname: O'Malley
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Farehin
authors.initials: F
authors.lastname: Khan
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Savanah
authors.initials: S
authors.lastname: Brooks
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects
keywords: pelvic irradiation; postoperative complications; robot-assisted cystectomy