Outcomes Of Palliative Cystectomy In Patients With Locally Advanced Pt4 Bladder Cancer

Background: Radical cystectomy (-) is the standard of care for muscle-invasive bladder cancer (BCa). In locally advanced pT4 BCa the oncologic outcome is inexplicit but - may be necessary for palliation.Objectives: The aim of this retrospective study was to evaluate the outcomes of - performed in patients with locally advanced pT4 BCa and to identify patient subgroups with improved outcome. Methods: Between 2008 and 2017, we identified 76 of 905 patients who underwent - for pT4 BCa at a single tertiary referral center. The physical patients' status was estimated according to the American Society of Anesthesiologists (ASA) classification. For the classification of postoperative complication rates, the Clavien-Dindo grading was used. Time-to-event variables with log-rank statistics were calculated with the use of the Kaplan-Meier method.Results: Median age was 74 years (range 42 & minus;90). Preoperatively, the physical status was estimated poor in 40 (52%) patients (ASAscore of >3). Overall, 19 (25%) patients had pT4b BCa, 41 (54%) patients were lymph node positive (c/pN+) and 14 (18%) patients had distant metastases (c/pM+). Within 30 and 90 days after surgery, 21% and 30% of the patients, respectively, developed severe complications (Clavien-Dindo grade >3). Overall, 30-and 90-day mortality rates were 9% and 11%, respectively. Moreover, 86% and 75% of patients who died within 30 and 90 days after surgery, respectively, had an ASA-score >3. At a median postoperative follow-up of 8 months (range 0 & minus;85), 53 (70%) patients have died. During the follow-up period, 46% of the patients died due to progressive disease, 16% died of a non cancer-specific cause, and for 8% of the patients, the reason remains unknown. Median overall survival (OS) and cancer-specific survival were 13.0 and 16.0 months, respectively. In subgroup analyses ASA-score >3 and hemoglobin <11.7 g/dl was significantly associated with poor OS. No statistically significant differences were detected between subgroups.Conclusion: Cx performed in patients with locally advanced pT4 BCa is associated with an increased mortality rate within 90 days postoperatively. Our study revealed that the ASA-score is a relevant and easily available tool to rate the patient's condition and estimate postoperative outcome. (C) 2020 Elsevier Inc. All rights reserved.