We conclude that salvage cystectomy can be performed safely after radiation, chemotherapy, or both. The success of salvage cystectomy depends highly on meticulous surgical technique and strict adherence to standard surgical principles. The results in selected patients justify its use, particularly after radiation therapy alone. The results in patients who have undergone definitive chemotherapy appear to depend more on the response to systemic therapy than on the surgical intervention, although the role of surgery has not yet been fully defined. We believe that diversions other than ileal conduit are possible in selected patients despite heavy pre-treatment with radiation, chemotherapy, or both.
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