Presentation Authors: Teck Wei Tan*, Singapore, Singapore, Kerri Beckmann, Ramesh Thurairaja, Muhammad Shamim Khan, Rajesh Nair, London, United Kingdom
Introduction: There remains a perception that cystectomy following prior pelvic irradiation (PPI) confers worse outcomes. With the increasing experience in robot assisted cystectomy (RAC), we report the feasibility and peri-operative outcomes of patients undergoing post-pelvic irradiation robot-assisted cystectomy (P-PIRAC) compared to RAC in patients without PPI.
Methods: We performed a prospective single-centre review of 529 patients treated with cystectomy from January 2009 to June 2018. 316 patients underwent RAC, of which 25 (7.9%) received PPI (Group A). This was compared with to 291 patients who did not receive PPI (Group B). Co-morbidities were quantified using the Charlson co-morbidity index (CCI), and peri-operative complications were recorded in each group.
Results: Patients in Group A were older (mean age 72 vs 68 years, p = 0.028) but fitter (ASA Score 3: 4% vs 16%, p=0.012). Whilst there was no statistically significant difference in baseline demographics (gender, race, body mass index), a greater number of patients in Group A received chemotherapy (44% vs 15%, p < 0.001)._x000D_
There was no differences in short and median term perioperative outcomes between the two groups (Table 1), and on multivariate analysis, only increasing age (OR 1.04, 95% CI 1.01 - 1.07, p = 0.017) and longer operative time (OR 1.005, 95% CI 1.001 - 1.009, p = 0.012) were associated a higher 90-day complication rate. PPI was not associated with an increased intra-operative (OR 0.62, 95% CI 0.13 - 2.86, p = 0.539) or 90-day complication rate (OR 0.82, 95% CI 0.25 - 2.68, p = 0.740) (Table 2).
Conclusions: P-PIRAC should be standard of care in high volume RAC units. It provides durable short and medium term outcomes and is a safe option with complication rates not dissimilar to RAC in patients without PPI.