59 years old manHx of stomach adenocarcinoma 20 years agoHx of chemoradiotherapycc:grosshematuria
Cytology:doubtful malignancy • PSA: 4.9 5.5 • Cr: 1.1 • USG: Bladder mass • TURBT&PROSTATE Bx was done
RADICAL CYSTOPROSTATECTOMY WAS DONE Ureteral frozen sections:negative
EAU • In all T1 tumours at high risk of progression (i.e. high grade, multifocality, carcinoma in situ, and tumour size, as outlined in the EAU EAU: European Association of Urologyguidelines for Non-muscle-invasive bladder cancer ), immediate radical cystectomy is an option. • In all T1 patients failing intravesical therapy, cystectomy should be performed.
Urothelial CIS with prostatic duct involvementprostate:GS 3+3left ureter:CIS
In the case of CIS, an attempt is made to achieve a negative margin without compromising ureteral length because nephrectomy is not indicated for CIS of the uretCIS of the ureter is not independently associated with a worse outcome following cystectomy (Lee et al, 2006). Cancer recurrence at the anastomosis is rare even with a positive margin showing CIS, but a positive margin is a risk factor for developing a second primary tumor of the ureter or renal pelvis (Lee et al, 2006; Raj et al, 2006).
Surveillance ureteroscopy is the most sensitive means for following patients with a positive ureteral margin, and long-term follow-up is required. The median time to occurrence in one recent series was 53 months (Wagner et al, 2008).
BJU Int. 2012 Mar;109(6):846-54. doi: 10.1111/j.1464-410X.2011.10455.x. Epub 2011 Aug 4. Factors influencing post-recurrence survival in bladder cancer following radical cystectomy. Bladder cancer recurrence forebodes poor prognosis, with 6 months' median survival following recurrence. Advanced pathological stage, positive surgical margins, high lymph node density and early recurrence portends poorer outcome. Although patients with local recurrence have a slightly better prognosis, those with disease recurrence at local and distant sites perform very poorly; nearly 97% of all patients with recurrence eventually succumb to the disease. Chemotherapy administration following recurrence may improve survival, although further studies are needed to exclude selection bias.
J Urol. 2010 Jun;183(6):2165-70. doi: 10.1016/j.juro.2010.02.021. Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. Positive soft tissue surgical margin is a strong predictor of recurrence and eventual death from urothelial carcinoma of the bladder. Soft tissue surgical margin status should always be reported in the pathological reports after radical cystectomy. Due to uniformly poor outcomes patients with positive soft tissue surgical margins should be considered for studies on adjuvant local and/or systemic therapy.
Eur Urol. 2013 Apr;63(4):739-44. doi: 10.1016/j.eururo.2012.09.053. Epub 2012 Sep 28. Prognostic value of perinodallymphovascular invasion following radical cystectomy for lymph node-positive urothelial carcinoma. CONCLUSIONS: We present the first explorative study on the prognostic impact of pnLVI. In contrast to other parameters that show the extent of LN metastasis, pnLVI is an independent prognosticator for CSS.
Prog Urol. 2012 Oct;22(12):705-10. doi: 10.1016/j.purol.2012.07.011. Epub 2012 Aug 29. [Radical cystectomy for urothelial bladder cancer: prognostic impact of lymph node metastasis and soft tissue surgical margins]. Positive soft tissue surgical margin and/or lymph node metatstasis on cystectomy specimen is a strong predictor of GS and SS from urothelial carcinoma of the bladder. So it is for capsular rupture, ganglionic density greater or equal to 0.10 and nb of N in lymphadenectomy less than 14 for pN+ patients.
J Urol. 2007 Dec;178(6):2308-12; discussion 2313. Epub 2007 Oct 22. Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. Risk factors for positive soft tissue surgical margins are female gender, locally advanced cancer, presence of vascular invasion and mixed histology. Patients with positive soft tissue surgical margins have poor prognosis, and positive soft tissue surgical margins were found to be independently associated with disease specific death.
World J Urol. 2011 Aug;29(4):451-6. doi: 10.1007/s00345-010-0581-z. Epub 2010 Jul 9. Sequential resection of malignant ureteral margins at radical cystectomy: a critical assessment of the value of frozen section analysis. FSA has a high accuracy for detecting malignant ureteral margins. Patients with positive final margins are at increased risk of UUT-R. With sequential resection, however, positive margins cannot reliably be converted to negative ones.
IntUrolNephrol. 2012 Dec;44(6):1705-10. doi: 10.1007/s11255-012-0224-y. Epub 2012 Jul 7. The incidence and relevance of prostate cancer in radical cystoprostatectomy specimens. The majority of incidental CaP in CP specimens are organ confined and do not influence oncological outcome. The prognosis of such patients is primarily determined by bladder cancer. Our findings support previous reports and autopsy studies elsewhere.