Introduction:

In patients undergoing major abdominopelvic surgery, history of prior abdominal surgery (PAS) is an established risk factor known to influence surgical complexity, peri-operative course, and patient outcomes. There are, however, limited data describing the impact of PAS on patients undergoing radical cystectomy for bladder cancer. The current study sought to evaluate the association of PAS with surgical and oncologic outcomes in patients undergoing radical cystectomy at a high-volume academic center. 

Methods:

The study cohort included consecutive patients undergoing radical cystectomy with ileal conduit diversion at a single institution from 2018 through 2020. Prospectively collected patient-level data were obtained from the medical record. Baseline comorbidities were quantified using the Charlson Comorbidity Index (CCI) and categorized as mild (CCI 1-2), moderate (CCI 3-4), and severe (CCI ≥5). The primary outcome was post-operative complications, categorized using the Clavien-Dindo classification (I-V). We performed multivariable analysis to determine the association of PAS with post-operative outcomes after adjustment for patient-level factors. 

Results:

The study cohort included 272 patients of median age 70 (65-75), of which 219 (80%) were male, 208 (76%) were current or prior smokers, and 131 (48%) had undergone PAS. Overall, 92 (33%) patients experienced a total of 170 Grade 2-5 complications. The incidence of Grade 2-5 complications was significantly higher in patients with PAS than those without (54% vs. 42%, p=0.028). On multivariable analysis adjusted for sex and CCI, prior abdominal surgery was associated with an approximate 32% increase in the odds of Grade 2-5 complication (OR 1.32, 95% CI 1.02-1.72, p=0.03). 

Conclusion:

In patients undergoing radical cystectomy for bladder cancer, a history of prior abdominal surgery was associated with increased rate of Grade 2-5 complications. As such, patients with PAS are likely to benefit from pre-operative interventions such as prehabilitation to mitigate risk and optimize the post-operative course. 

Funding: N/A