Transitional cell carcinoma recurrence impacting intestinal diversion after radical cystectomy. Oncologic outcomes of a rare site of recurrence.

bladder cancer radical cystectomy recurrence transitional cell carcinoma undiversion urinary diversion urinary diversion/adverse effects

Journal

Central European journal of urology
ISSN: 2080-4806
Titre abrégé: Cent European J Urol
Pays: Poland
ID NLM: 101587101

Informations de publication

Date de publication:
2020
Historique:
received: 12 06 2020
revised: 04 11 2020
accepted: 15 11 2020
entrez: 8 2 2021
pubmed: 9 2 2021
medline: 9 2 2021
Statut: ppublish

Résumé

Transitional cell carcinoma recurrence within an intestinal urinary diversion (TCCUD) after radical cystectomy (RC) is a rare condition with unknown origin, prognosis and treatment. The aim of this study was to describe treatment options and oncologic outcomes of this understudied site of recurrence in a multi-institutional case series. TCCUD relapse cases after RC were investigated in a retrospective, multi-institutional study. Surgical approach and adjuvant chemotherapy were discussed. Early and late complications were described according to the Clavien-Dindo classification. Kaplan-Meier method was used to assess progression-free and cancer-specific survival. A total of 19 patients were selected. The most common presentation was gross hematuria. The median interval between RC and TCCUD was 51.2 months. Fifteen patients (78.9%) underwent surgical excision, and two underwent concomitant radical nephroureterectomy. In 12 (63.1%) cases the site of TCCUD was the uretero-ileal anastomosis. Tumor invading the muscularis of the intestinal diversion was described in 10 (52.6%) cases. Surgical complications occurred in 7/15 (46.6%) patients, of these two with Clavien-Dindo Grade III. Four patients (21.0%) underwent adjuvant chemotherapy and two (10.5%) both chemotherapy and radiation therapy. During follow-up 15 patients (78.9%) presented with other sites of recurrence, with lymph nodes (21.0%) and liver (15.7%) being the most common localizations. Recurrence free and overall survival rates were 36.8% and 15.8%, and 56.5% and 24.2%, respectively at 12 and 18 months. Most patients with TCCUD have invasive disease and a substantial percentage experience upper tract cancer during their disease course. TCCUD is often the herald of advanced disease and systemic progression, with poor progression-free and overall survival rates.

Identifiants

pubmed: 33552570
doi: 10.5173/ceju.2020.0168.R1
pii: 0168
pmc: PMC7848846
doi:

Types de publication

Journal Article

Langues

eng

Pagination

445-456

Informations de copyright

Copyright by Polish Urological Association.

Déclaration de conflit d'intérêts

All authors declare that have no conflict of interest.

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Auteurs

Fabio Zattoni (F)

Urology Unit, Academical Medical Centre Hospital, Udine, Italy.

Iliana Bednarova (I)

Division of Radiology, Gorizia Hospital, Gorizia, Italy.

Alessandro Morlacco (A)

Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

Giovanni Motterle (G)

Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

Paolo Beltrami (P)

Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

Fabrizio Dal Moro (F)

Urology Unit, Academical Medical Centre Hospital, Udine, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

R Jeffrey Karnes (RJ)

Department of Urology, Mayo Clinic, Rochester, MN, USA.

Classifications MeSH