Objectives. 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 Januar
y 1995 and June 2000 by a single surgeon. Twenty-three patients were identi
fied with a history of external beam radiotherapy to the pelvis (EBRT group
), and 23 additional patients without a history of pelvic radiation were ra
ndomly selected to serve as the control group.
Results. Although the overall risk of having a complication was not statist
ically 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% ve
rsus 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 contro
l group developed a symptomatic fluid collection.
Conclusions. Cystectomy after pelvic radiation is associated with acceptabl
e 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 t
he risk of a symptomatic fluid collection. (C) 2001, Elsevier Science Inc.