Is frozen section analysis of the urethra at the time of radical cystectomy and orthotopic neobladder urinary diversion mandatory?

Sureka, Sanjoy Kumar; Yadav, Abhishek; Arora, Sohrab; Kapoor, Rakesh; Mandhani, Anil

doi:10.4103/0970-1591.163309

Cited by 7 publications

(2 citation statements)

References 23 publications

(37 reference statements)

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“…For women, some urologists consider a bladder neck biopsy to be oncologically equivalent to urethral FSA [35]. To evaluate this further, a retrospective study analyzed outcomes of 297 women who underwent RC with OBS for BC in four centers between 1994 and 2011 [13].…”

Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

et al. 2017

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Context Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs). Objective To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC. Evidence acquisition A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors. Evidence synthesis Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4–10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of ther distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26–155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective. Conclusions SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment. Patient summary Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4–10% of patients after radical removal of the bladder for bladder cancer. These patients’ prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.

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Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

et al. 2017

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“…EAU guidelines also recommend the use of FSA of the ureters at the time of surgery [2,5]. However, the use of ureteric FSA at the time of surgery remains a point of much debate [6,7,8,9]. …”

Section: Discussionmentioning

confidence: 99%

Utility of Routine Intraoperative Ureteral Frozen Section Analysis at Radical Cystectomy: Outcomes from a Regional Australian Center

et al. 2019

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Introduction: The objective of this study was to look at the usefulness and cost effectiveness of intraoperative frozen section analysis (FSA) of the ureters at the time of radical cystectomy. Methods: Pathology notes of patients undergoing radical cystectomy for primary bladder cancer between the years 2000-2015 at our institution were reviewed. Results: A total of 196 ureteric specimens from 98 patients were reviewed. Of the 98 patients, 9% (n = 9) had positive ureteric margins, of which all were ≥ T2, with 44% (4 of 9) being T = 4. In all cases of positive FSA, preoperative clinical staging was ≥ T2. In cases where cancer staging was upgraded post-cystectomy, there were no cases of positive FSA. After adjusting for tumor stage in ≥ T2a, using Cox regression analysis, positive frozen section was associated with a 4.2 fold increase in overall mortality (95%CI 1.3-13.8; p = 0.02). Cost associated with FSA was AU$1,351.90 to obtain 1 positive result. Conclusion: Patients with positive ureteric FSA are at higher risk of mortality post cystectomy, despite excision to negative tissue. However, FSA of the distal ureters at cystectomy were unlikely to be positive unless the bladder cancer stage was ≥ T2. Hence, routine ureteric FSA may not be necessary in patients undergoing cystectomy for non-muscle invasive bladder tumors.

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The Accuracy of Sequential Urethral Frozen Section and its Impact on Urethral Recurrence After Radical Cystectomy

Gakis

Schmid²,

Hassan

et al. 2022

Clinical Genitourinary Cancer

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Is frozen section analysis of the urethra at the time of radical cystectomy and orthotopic neobladder urinary diversion mandatory?

Cited by 7 publications

References 23 publications

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

Utility of Routine Intraoperative Ureteral Frozen Section Analysis at Radical Cystectomy: Outcomes from a Regional Australian Center

The Accuracy of Sequential Urethral Frozen Section and its Impact on Urethral Recurrence After Radical Cystectomy

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