Elsevier

Urology

Volume 148, February 2021, Pages 198-202
Urology

Oncology
Feasibility and Outcomes of Orthotopic Ileal Neobladder Reconstruction Following Pelvic Irradiation

https://doi.org/10.1016/j.urology.2020.09.014Get rights and content

OBJECTIVES

To evaluate the complications and oncologic outcomes of orthotopic ileal neobladder reconstruction (ONB) following pelvic radiotherapy (RT) compared to patients with no prior pelvic RT.

METHODS

Our institutional database was queried for all patients with pT0-4bN0-3M0 urothelial carcinoma of the bladder who underwent radical cystectomy with curative intent and ONB between 1990 and 2018. We then queried this cohort for patients who had prior pelvic RT (>3900 cGy) and compared baseline characteristics, perioperative complications, and recurrence free survival between patients with and without prior pelvic RT.

RESULTS

One thousand eight hundred and forty-six patients matched our inclusion criteria; 34 had prior pelvic RT with a median dose of 6280 cGy. Prior RT targeted the bladder, prostate, and cervix in 27, 6, and 1 patient, respectively. Median time from RT to cystectomy was 15.5 months. Patients with prior RT had a longer time from diagnosis to cystectomy, more frequently had ≥5 TURBT and neoadjuvant chemo, and less frequently had multifocal disease. Perioperative complications including operative time, estimated blood loss, days hospitalized, as well as 30- and 90-day complication rates, were not statistically different. There was no statistical difference in recurrence free survival between the 2 groups (P = .48).

CONCLUSION

ONB in highly selected patients with prior pelvic RT is feasible with statistically similar perioperative complication rates compared to ONB without prior RT.

Section snippets

MATERIAL AND METHODS

Our institutional database was queried for all patients with pT0-4bN0-3M0 urothelial carcinoma who underwent RC with curative intent and ONB between 1990 and 2018. Patients who underwent robotic procedures were not included in this study. We then queried this cohort for patients who had prior pelvic RT for any pelvic malignancy. Only patients with radiation records that could be abstracted from the medical record were included. We limited the patients with prior RT to those that had received

Baseline Characteristics

Of the 2693 patients included in our query, 217 had prior RT. Of those who underwent ONB, 82 of 1846 had prior pelvic RT. We excluded 48 of 82 RT patients that lacked records specifying dose and/or field of radiation or had <3900 cGy directed to the pelvis (Fig. 1). The remaining 34 patients received ≥3900 cGy to the pelvis with a median of 6280 cGy (range, 3910-7910 cGy). RT was directed to the bladder, prostate, and cervix in 27, 6, and 1 patient, respectively, with a median time from

CONCLUSION

This study shows ONB in highly-selected patients with prior pelvic irradiation is feasible with statistically similar perioperative complication rates compared to ONB performed in the setting of no prior radiation. The findings provide reassurance that, when necessary, all reconstructive options are available to patients who decide to undergo bladder-preservation therapy.

References (13)

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Cited by (2)

Declarations of Interest: None to report.

Financial support: This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors. We acknowledge the Norris Cancer Center Support Grant P30 CA014089. There are no financial conflicts of interest.

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