Lymphovascular invasion, ureteral reimplantation and prior history of urothelial carcinoma are associated with poor prognosis after partial cystectomy for muscle-invasive bladder cancer with negative pelvic lymph nodes

Ma, Baojing; Li, Haimin; Zhang, C.; Yang, Kailin; Qiao, Baomin; Zhang, Z.; Xu, Yong

doi:10.1016/j.ejso.2013.04.006

Cited by 30 publications

(19 citation statements)

References 18 publications

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“…Recognised early indicators for oncology efficacy in surgical management of urothelial carcinoma include positive surgical margin rates and lymph node yields . Our positive margin rate was 3.4%, consistent with other single institution PC series that have reported rates of 0–14% . For PLND, studies have shown the underutilisation of PLND, with performance rates as low as 23% , which may contribute to historical accounts of poor PC outcomes.…”

Section: Discussionsupporting

confidence: 83%

Robot‐assisted partial cystectomy: perioperative outcomes and early oncological efficacy

et al. 2016

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ObjectiveTo report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological variables, as well as the overall oncological efficacy of this approach. Patients and MethodsWe retrospectively reviewed all patients who underwent RAPC by a single surgeon between 2005 and 2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumour. Clinicopathological data and perioperative variables were recorded. Continuous variables were compared using the Student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intra-diverticular neoplasms was done using univariate logistic regression. Survival was estimated using the Kaplan-Meier method. ResultsThe median (interquartile range) patient age was 75 (65-81) years, 18 patients (62.1%) had an American Society of Anesthesiologists classification of ≥3, and 10 patients (34.5%) had a history of prior abdominal surgery. The median estimated blood loss (EBL) was 50 mL and the median length of stay (LOS) was 1 day. Two patients (6.9%) had a perioperative complication and five (17.9%) a post-discharge complication at ≤90 days, all of which were minor. The positive surgical margin rate was 3.6% and in those with muscle-invasive disease a median of 12 lymph nodes were removed. Neither the size of diverticulum nor the need for ureteric re-implantation was predictive of LOS, EBL, or complication (P > 0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncological outcomes. The 5-year overall and recurrence-free survival rates were 79% and 68%, respectively. ConclusionRAPC confers the ability to achieve favourable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favourably with the published literature. For experienced surgeons, this may represent the optimal surgical approach for organ-preserving bladder surgery.

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Section: Discussionsupporting

confidence: 83%

Robot‐assisted partial cystectomy: perioperative outcomes and early oncological efficacy

et al. 2016

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“…This, as well as the generally more elderly and unwell patients, may explain the decreased use of adjuvant chemotherapy in PC patients. These population data show a slightly higher local stage at PC than prior published population and single-center series, likely reflecting the analysis of urothelial cancer in isolation, while suggesting differences in patient selection or time to surgery in the population at large [8,9,[19][20][21]. It is notable that no lymph node pathologic data was available for 67% of PC cases in our series (and 24% of RC), suggesting that PLND was not considered part of the surgical procedure, possibly to decrease operative time and/or morbidity.…”

Section: Cuaj -Original Researchmentioning

confidence: 43%

“…A handful of published reports have suggested that PC has comparable oncologic and survival outcomes to RC, however these reports predominately come from singlecenter series [7][8][9]. Partial cystectomy data often includes non-urothelial cancers and are therefore difficult to compare with radical cystectomy.…”

Section: Introductionmentioning

confidence: 99%

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Partial cystectomy for urothelial carcinoma of the bladder: Practice patterns and outcomes in the general population

Leveridge

Izard

Wei

et al. 2017

CUAJ

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Introduction: Partial cystectomy (PC) for urothelial carcinoma (UC) in selected patients may avoid the morbidity of radical cystectomy (RC). We describe utilization and outcomes of PC for UC in routine clinical practice. Methods: All patients with urothelial carcinoma of the bladder (UCB) undergoing PC or RC in Ontario from 1994-2008 were identified using the Ontario Cancer Registry and linked electronic records. Pathology reports were reviewed. Variables associated with PC use were identified using logistic regression. Cox proportional hazards model identified factors affecting cancer-specific (CSS) and overall survival (OS). Results: A total of 3320 patients underwent PC (n=181; 5%) or RC (n=3139; 95%) from 1994-2008. PC patients were older (36% 80+ years vs. 19%; p<0.001) and more likely to have organ-confined (

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“…[10] As summarized in Table 1, overall 5-year survival for patients undergoing partial cystectomy for MIBC is between 50% and 70%, with up to 81% of patients retaining their native bladder at 10 years. [910121315192021]…”

Section: Partial Cystectomymentioning

confidence: 99%

Where are we with bladder preservation for muscle-invasive bladder cancer in 2017?

et al. 2017

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Introduction:In 2017, neoadjuvant, cisplatin-based chemotherapy followed by radical cystectomy (RC) is considered the gold standard therapy for muscle-invasive bladder based on randomized controlled trials. Across all tumor stages, this approach has been associated with the highest rates of disease-specific survival. However, RC is one of the most challenging procedures performed by urologic surgeons and carries with it significant risks of complications, hospital readmission, and even a small risk of mortality, in addition to lifestyle changes that can have long-term effects on well-being. For these reasons, bladder-sparing approaches are utilized in some highly selected patients. We reviewed the most recent evidence for bladder-sparing modalities for muscle-invasive urothelial bladder cancer and summarize those findings in this review article.Methods:We performed a PubMed literature review utilizing the key words “bladder preservation,” “trimodal therapy,” “muscle-invasive bladder cancer,” and “partial cystectomy” written in English, dating back to 1990. We excluded case reports.Results:Our search yielded more than 2000 articles which we screened. Some articles were then rejected due to inappropriate topic. In addition, we reviewed the most recent American Urological Association, National Comprehensive Cancer Network (NCCN), and European guidelines on muscle-invasive bladder cancer. We identified fifty relevant articles which are summarized in this text. In some rare instances, recommendations are based on expert opinion.Conclusions:Bladder preservation is often considered for quality of life considerations or in the setting of multiple medical comorbidities, and this remains oncologically appropriate even in 2016 in highly selected patients with muscle-invasive urothelial carcinoma of the bladder.

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Lymphovascular invasion, ureteral reimplantation and prior history of urothelial carcinoma are associated with poor prognosis after partial cystectomy for muscle-invasive bladder cancer with negative pelvic lymph nodes

Cited by 30 publications

References 18 publications

Robot‐assisted partial cystectomy: perioperative outcomes and early oncological efficacy

Robot‐assisted partial cystectomy: perioperative outcomes and early oncological efficacy

Partial cystectomy for urothelial carcinoma of the bladder: Practice patterns and outcomes in the general population

Where are we with bladder preservation for muscle-invasive bladder cancer in 2017?

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