Predictive value of urethal frozen section during radical cystectomy for bladder cancer: to detect and prevent urethral recurrence

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MANAGEMENTOFINVASIVEUROTHELLALCANCER Tuesday,Fabruary 26,13.45-15.15 hrs,RoomC

PREDICTIVE RADICAL

VALUE

OF URETHAL

CYSTECTOMY

FROZEN

FOR BLADDER

SECTION

CANCER:

DURING

TO DETECT

ANDPREVENTURETHRALRECURRENCE

SIGNIFICANCE OF PELVIC PROGNOSIS AFTER RADICAL

LYMPHADENECTOMY CYSTECTOMY

FOR

THE

Leissner Joachim’, Hohenfellner Rudolf-‘, Wolf Helmut”. Allhoff Ernst’

Botto Henry, Barhagelatta Michel, MoliniC Vincent. BarrC Philippe, HervC JeanMarie, Lugagne Pierre-Marie.

538

537

Lebret Thierry

‘Urology, Otto-von-Guericke-University, Magdeburg, Germany, ‘Pathology, Klinikum Lippe-Detmold. Detmold, Germany. -‘Urology, Johannes GutenbergUniversity, Mainz, Germany

Urology, Hopital Foch. Suresnes, France

(RCT) to detect and prevent urethral carcinoma recurrence.

INTRODUCTION & OBJECTIVES: In contrast to other carcinomas such as breast or colon cancer, there are no guidelines regarding the number and location of lymph nodes to be removed during radical surgery in patients with invasive bladder carcinoma. The therapeutic effect of pelvic lymphadenectomy and its influence on tumour staging has not been documented yet.

MATERIALS

MATERIALS

INTRODUCTION

& OBJECTIVES:

To assess the predictive

value of

pathological frozen section of the transected urethra during radical cystectomy

& METHODS:

From 1982 to 1996,400

urethral frozen section

(FS) were systematically performed during RCT procedure. When either CIS, severe dysplasia or carcinoma were presence the FS was defined as positive. At the opposite. absence of these pathological tissue define negative FS.

RESULTS:

377 FS were negative while 23 were positive leading to an

urcthrectomy

(5.75%).

Among these 23 urethrectomies,

only one definitive

pathological examination was normal (false positive result of FS). Out of these 23 patients with positive FS only I1 had a bladder carcinoma with classical urethral involvement risk (bladder cancer either diffuse or involving trigona or bladder neck). Of the 377 negative FS, IO urethral recurrences happened during extensive

follow-up

consecutive

RCT,

(median with

8.3

sytematic

years. 3-14 frozen

Finally.

among 400

section, there were

years).

32 urethral

recurrences and/or involvement (8%). 22 detected by FS.

CONCLUSION: and/or

& METHODS: Here we present an evaluation of pelvic lymph nodes from 484 patients who underwent radical cystectomy in two urological institutions with curative intention between 1986 and 1999. The number of lymph nodes was correlated with the depth of invasion of the primary tumour, occurrence of nodal metastases, clinical outcome, the operating surgeon, and the pathologist.

FS predict or identify 69% (22132) of urethral recurrence

involvement

replacement.

and therefore

allows

a more reliable

Then, for us, it is mandatory to perform

use of bladder

it after RCT

before

enteroplasty.

RESULTS:

There were 484 patients with a mean age of 62.7 years. Clinical follow up was available from 32 I patients with a mean follow-up period of 35.9 months. The average number of lymph nodes removed was 14.3 (1-46). The number of lymph nodes removed (cut-off value 15 lymph nodes) varied significantly between different surgeons and did not correlate with the pathologists. There was a significant correlation between the number of lymph nodes and the tumour-free survival in pT2 and pT3 tumours and in patients without lymph node metaatases. Multivariate analysis revealed that pT-stage (p
CONCLUSIONS:

The more extensive lymphadenectomy significantly improved the prognosis of patients with invasive bladder cancer and therefore, represents a potentially curative procedure. The results indicate a need for a standardised lymph node dissection.

540

539 THE RELATIONSHIP OF LOCAL TO DISTANT PATIENTS LYMPH NODE POSITIVE CYSTECTOMY

FAILURE AFTER

IN PELVIC RADICAL

MANAGEMENT OF NODAL BLADDER CANCER Solaona E.. Iborra I., RI&

Madershacher Steohan, Thalmann George, ‘Markwalder

INVOLVEMENT

IN PATIENTS

WITH

J.V., Mom& J.L., Dumont R., Rubio J.. Casanova J.L

Regula. Studer Urs Department of Urology I.V.O. Valencia, Spain

‘Departments of Urology, University of Berne. Inselspital. Switzerland, ‘Departments of Pathology, University of Berne, lnaelapital. Switzerland

INTRODUCTION & OBJECTIVES: The aim of this study was to determine (i) the general outcome and (ii) the relationship of local failure to distant metastahes in patients with pelvic lymph node metastases following radical cystectomy for invasive transitional cell cancer of the bladder. MATERIAL

& METHODS:

This study evaluates SO7 cases of invasive bladder cancer staged as NOM0 preoperatively who underwent radical cystectomy with extensive bilateral pelvic lymph node dissection between I985 and 2000. Positive lymph nodes were confirmed histologically in I22 (24%) patients. Pathologic tumour stage based on the 1997 TNM system. overall rccurrcnce free survival and metastatic patterns were determined in these I22 patient\.

RESULTS:

Median recurrence free and overall survival was 9.7 months and 15.4 months, respectively. Tumour progression was observed in 78 patients (64%) and 44 (36%) remained free of disease; 69 (57%) died of recurrent cancer. I7 of other causes (14%) and 37 (30%) were alive at the time of analysis. The number of patients remaining free of dihcase (NED). developing an isolated local recurrence or distant metaataseh and stratified according tumour stage is listed below.

1NED pTI (n=2) I (50%) pT2 (n=26) I4 (54%) pT3 (n=62) 24 (39%) pT4 (n=32) 15 (16%) Overall (n=122) 144 (36%)

1Isolated local recurrence

1Distant metastases / I (50%)

2 (8%) 7( I I’%) 17 (22%)

IO (38%) 3l(50%) 120 (62%)

1I6

162 (5 1%)

(13%)

INTRODUCTION: The management of nodal involvement in patients with bladder cancer remains controversial. Radical cystectomy and pelvic lymphadenectomy has proved its therapeutic value in selected patients. Cisplatin-based neo and adjuvant chemotherapy also has been used in some of these patients. Nevertheless the optimal schedule in patients with nodal involvement remains to be established. OBJECTIVE: To analyze prognostic factors which are able to identify subgroup\ of patients in order to apply different therapies.

MATERIAL AND METHODS: We analysed I42 patients with bladder cancer candidates to radical cystcctomy and with nodal involvement in PLND and with a follow-up of more than 2 years. On these patients we selected 107 treated with radical cyatectomy and pelvic lymphadenectomy with complete nodal excision. Patients were stratified according to nodal extension (TNM), pathological local stage, organ (pTI2b) and non-organ confined (pT3a-Tab) and patients treated with cystectomy alone, neo-adjuvant chemotherapy and those receiving adjuvant chemotherapy. Uni. And multivariate analysis for predicting progression was carried out including clinical f&tors. pathological factors and therapy applied.

RESULTS: In uni and multivariate analysis, nodal extension and the therapy applied wcrc significant and independent variables. The Worse prognosis was observed in patients treated with neo-adjuvant chemotherapy with cause-specific mortality of 86.3% V?I. 57.4% in those treated with cystectomy alone vs. 38.7% in patients receiving ndjuvant chemotherapy (pO.OS-): 3) in patients with pNI adjuvant chemotherapy improved the survival of patients treated with surgery alone but this difference wa\ not algnificant (p>o.OS) and 4) in patients with pN2-3, there is a significant increase of survival in those treated with ndjuvant chemotherapy compared to patients treated wjith surgery alone (p
CONCLUSIONS:

Long term survival is possible in patients with lymph node metastases undergoing radical cystectomy and extensive pelvic lymph node dissection. With higher tumour stages there is a linear increase of local and distant failure in patients with pelvic lymph node metastases.

CONCLUSIONS:

In patients with bladder cancer and nodal involvement pNI, surgery alone can be enough as therapy approach. However, in patients with pN2-3, adjuvant chemotherapy might be considered.

European Urology Supplements 1 (2002)No. 1, pp. 137