Introduction:
Complications after radical cystectomy (RC) are common and well described. However, few reports describe long term complications, especially those necessitating intervention. Maine is a rural state where most cystectomy care is provided by a single academic center. A statewide health information exchange allows access to outside records and thorough post-RC follow up. We sought to examine the risk of any intervention or operation that may be related to RC and describe the short and long-term complications that occur most frequently.
Methods:
Our single institution prospectively maintained database identified 256 consecutive patients who underwent RC from 2015-2022. All charts, including information from a statewide health information exchange, were reviewed. Follow up was included if the patient had seen a urologist, PCP, or medical oncologist. All interventions (i.e. IR procedures, ureteroscopy) and operations possibly related to RC were recorded and classified. Intervention categories were “any”, “urinary”, “bowel”, “hernia”, “wound”, “abscess/lymphocele”, or “rare”.
Demographics and treatment variables were compared between those who had any post-RC intervention and those without. Multivariable analysis was performed to evaluate for factors associated with any intervention and separately by classification while controlling for demographics and treatment variables. A time to event analysis was conducted to determine the rate and timing of re-intervention after RC.
Results:
95/256 (37.1%) of patients had at least 1 additional intervention and 44 (17.2%) had multiple. Median follow up was 19.1 months and 83.5% of living patients had been seen within the preceding 12 months. Higher BMI, longer case duration, and neobladders were at risk for intervention (Table 1). Interestingly, patients receiving neoadjuvant chemotherapy (NAC) were less likely to have a post-RC intervention.
Reinterventions occurred at different times depending on type (Figure 2). A majority of first interventions often occurred within 365 days, but 40/125 (32%) of interventions happened more than 1-year post-RC. Notably, ureteroanastomotic stricture most often occurred between 90-365 days.
Multivariable analysis showed neobladder diversion to be associated with any additional intervention (OR3.29, 95%CI 1.24-8.75, p=0.017) and urinary intervention (OR3.82, 95%CI 1.29-11.27, p=0.015). Receipt of NAC was protective; any (OR0.31, 95%CI 0.17-0.57, p<0.001), urinary (OR0.31, 95%CI 0.15-0.65, p=0.002). No other factors were associated in sub-analysis of remaining groups.
Conclusion:
Complications leading to reoperation are common after RC with 37.1% of patients eventually needing reintervention. While many series report 90-day complications, we have shown that less than half of complications requiring intervention are observed during this time period and furthermore, one-third of interventions happen greater than one year after initial surgery. The timing of intervention after RC depended on the intervention classification. Most wound and infection interventions occurred early (<90 days), hernia interventions occurred late (>365 days), and urinary and bowel complications/interventions occurred throughout all time points. Long term and thorough follow up after RC is challenging, but with a single institution providing most cystectomy care and a statewide health information exchange allowing access to outside records, we demonstrate that following RC, bladder cancer patients remain at high risk for reintervention for an extended time and should be counseled on these risks.
Funding: n/a
Image(s) (click to enlarge):
LONG TERM REOPERATION AND COMPLICATION RISK AFTER RADICAL CYSTECTOMY
Category
Bladder Cancer > Muscle Invasive Bladder Cancer
Description
Poster #1
Wednesday, November 30
1:00 p.m. - 2:00 p.m.
Presented By: Joshua Linscott
Authors:
Joshua Linscott
Randie E White
Nicholas Hansen
Evelyn James
Stephen Ryan
Matthew H Hayn
Jesse Sammon