Urinary diversion-related outcome in patients with pelvic recurrence afterradical cystectomy for bladder cancer

Objectives. To evaluate the impact of urinary diversion on disease status, complications, and subsequent treatment in patients with pelvic tumor recur rence after radical cystectomy for bladder cancer. Methods. A retrospective review of 201 consecutive cases of radical cystect omy 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 w ith tumor recurrence was an ileal conduit, continent cutaneous diversion, o r orthotopic neobladder in 19, 3, and 11 patients, respectively. The mean f ollow-up for all patients undergoing cystectomy was 25.9 months (range 8 to 75). The mean time to diagnosis of local disease recurrence after cystecto my was 13.9 months (range 5 to 50). Results. In 21 (63.6%) of 33 patients, pelvic recurrence and systemic metas tasis were present simultaneously. Disease recurrence was associated with p oor outcome: only 8 patients (24.2%) were alive and disease free, 7 of whom had isolated local recurrence without evidence of systemic metastasis. The re was no difference in overall survival or type of therapy delivered once disease recurrence was diagnosed between patients with an orthotopic neobla dder and those with a cutaneous (continent or incontinent) urinary diversio n. The only diversion-related complication resulting from pelvic recurrence was 1 case of tumor invasion into an orthotopic neobladder, requiring conv ersion 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 surv ival once pelvic recurrence was diagnosed. Patients at high risk of pelvic recurrence should not be excluded from receiving an orthotopic urinary dive rsion. UROLOGY 53: 999-1004, 1999. (C) 1999, Elsevier Science Inc. All righ ts reserved.