Complications of cystectomy in patients with a history of pelvic radiation

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.