National Cancer Institute®
Last Modified: February 1, 2002
UI - 11521797
AU - Hussain SA; Moffitt DD; Glaholm JG; Peake D; Wallace DM; James ND
TI - A phase I-II study of synchronous chemoradiotherapy for poor prognosis locally advanced bladder cancer.
SO - Ann Oncol 2001 Jul;12(7):929-35
AD - CRC Institute for Cancer Studies. University of Birmingham, Edgbaston, United Kingdom.
BACKGROUND: The management of locally advanced bladder cancer remains controversial with poor local control with radiotherapy alone. Synchronous chemotherapy regimens have yielded encouraging results in other primary sites. PATIENTS AND METHODS: Patients with T2-T4a N0/NX M0 bladder cancer were entered into this single centre phase I-II study. Patients received radiotherapy to 55 Gy in 20 fractions over four weeks. Concurrent chemotherapy was given with Mitomycin C 12 mg/m2 day 1 and 5-fluorouracil 500 mg/m2/24 hours weeks one and four of radiotherapy for five or seven days on each occasion. RESULTS: Thirty-one patients schedule). Median age was 68 (range 58-79) years, 23 males and 8 females. T2: 9 (29%); T3a: 4 (12%); T3b: 9 (29%); T4: 9 (29%); TCC grade 2: 8 (26%) and grade 3: 23 (74%); 14 of 31 had hydronephrosis. Ten of thirty-one had a GFR < 50 ml/min. Toxicity was mild to moderate with the five-day schedule. More severe toxicity was seen with the seven-day schedule: five of nine patients failed to complete planned therapy. Pathological complete response rate at three months was 74% (5-day regimen) and 50% (7-day regimen). Overall 12-month survival was 65%. CONCLUSION: Chemoradiotherapy with the five-day schedule is feasible with acceptable toxicity in poor prognosis patients. A randomised trial is being launched.
UI - 11552789
AU - Syed HA; Biyani CS; Bryan N; Brough SJ; Powell CS
TI - Holmium:YAG laser treatment of recurrent superficial bladder carcinoma: initial clinical experience.
SO - J Endourol 2001 Aug;15(6):625-7
AD - Department of Urology, Leighton Hospital, Crewe, UK.
PURPOSE: To review our initial experience with the holmium laser in patients with recurrent superficial bladder cancer. PATIENTS AND METHODS: We treated 41 patients having 71 recurrent superficial laser treatment was carried out as a part of the follow-up flexible cystoscopy protocol, and topical anesthesia was used. The mean follow-up was 14 months (range 3-33 months). RESULTS: There were 13 recurrent tumors in the treated area and 38 recurrences in the untreated areas. Of interest, a subgroup of 10 patients were treated before 1994 with cystodiathermy and later on with the holmium:YAG laser at various times during their follow-up. The local recurrence rate with cystodiathermy was 32% compared with 10% after laser treatment (P = 0.39). A questionnaire study of 33 patients showed complete satisfaction with the treatment. Only 2 (6%) elected to have a further procedure under general anesthesia. In the series, 83% scored their pain as 2 or less of 10 on a visual analog scale. CONCLUSIONS: The absence of complications, high patient satisfaction, and ability to be used in the outpatient setting make the holmium:YAG laser an attractive alternative in the treatment of recurrent superficial cancer of the bladder.
UI - 11816482
AU - Hinotsu S; Akaza H; Isaka S; Kagawa S; Koiso K; Kotake T; Machida T;
TI - Matsumura Y; Niijima T; Obata K; Ohashi Y; Ohe H; Shimazaki J; Tashiro K; Japanese Urological Cancer Research Group for Adriamycin/Farumorubicin [Intravesical instillation of doxorubicin or epirubicin for chemoprophylaxis of superficial bladder cancer--the fifth study of the Japanese Urological Cancer Research Group for Adriamycin/Farumorubicin]
SO - Gan To Kagaku Ryoho 2002 Jan;29(1):73-80
AD - Faculty of Medicine, University of Tokyo.
A total of 465 patients with primary and multiple or recurrent, stages Ta and T1 superficial bladder cancer were included in this randomized multicenter trial to compare the prophylactic effect by 17 times instillation of 40 mg doxorubicin or 40 mg epirubicin with no instillation after transurethral resection of tumor(s). The primary endpoint was first recurrence after transurethral resection. Endoscopic examination as well as urinary cytology was performed in each case every three months. It became evident that the recurrence rate in the doxorubicin or epirubicin instillation arm was lower that in the no instillation arm. Toxicity was mainly restricted to bladder irritation in about 10% of patients in each instillation arm.
UI - 11737479
AU - Saika T; Suyama B; Murata T; Manabe D; Kurashige T; Nasu Y; Tsushima T;
TI - Kumon H Orthotopic neobladder reconstruction in elderly bladder cancer patients.
SO - Int J Urol 2001 Oct;8(10):533-8
AD - Department of Urology, Okayama University Medical School, Okayama, Japan. Takasaika@aol.com
BACKGROUND: We compared the clinical results of orthotopic neobladder reconstruction in elderly patients and those in younger patients retrospectively in order to verify whether age is a critical factor in selecting a method of urinary diversion. METHODS: Following radical cystectomy for bladder cancer, 12 patients aged 75 or older and 17 patients under 75 who underwent orthotopic neobladder reconstruction authors TS and BS were among the surgeons who performed operations for all cases. Of the 12 elderly patients, orthotopic neobladders were constructed according to Hautmann's method in nine cases, Studer's method in one case and Reddy's method in two cases. Of the 17 younger patients, these methods were employed in 12, one and four cases, respectively. Operative procedure, early and late complications, prognosis, continence and voiding pattern were investigated in these patients. RESULTS: The follow-up periods for elderly and younger groups ranged from 21.3 to 82.7 months and from 8.8 to 94.2 months, respectively. No difference in operation time, amount of bleeding or postoperative length of hospitalization was observed between elderly and younger patients. The rates of early complications in elderly and younger patients were 41.7% and 35.3%, respectively. Late complication rates were 33.3% and 47.1%, respectively. The difference in these complication rates was not statistically significant. One of the elderly and two of the younger patients had local recurrence and metastasis postoperatively. Those three patients had died of their bladder cancer. No statistically significant difference between groups was recognized in either cause-specific survival or overall survival, nor was there such a difference in relation to micturition/continence. CONCLUSION: Based on these results, we believe that because age is not a critical factor in the selection of urinary diversion method, neobladder reconstruction following cystectomy for bladder cancer is indicated in elderly patients. As stoma management is difficult for the patients, we consider orthotopic neobladder reconstruction to be the method of choice if the patients' general physical condition allows.
UI - 11776628
AU - Shou J; Ma J; Xu B
TI - [Adenocarcinoma of the urinary bladder: a report of 27 cases]
SO - Zhonghua Zhong Liu Za Zhi 1999 Nov;21(6):461-3
AD - Department of Urology, Cancer Hospital, Chineses Academy of Medical Science, Peking Union Medical College, Beijing 100021.
OBJECTIVE: To analyze the therapeutic results of urinary bladder adenocarcinoma. METHODS: Twenty-seven urinary bladder adenocarcinoma patients were treated from 1970 through 1997. There were 12 cases of urachal adenocarcinoma and 15 cases of bladder adenocarcinoma. Hematuria with or without urinary tract irritation symptoms was the most common clinical manifestation. RESULTS: The overall 5-year survival rate was 25.9%. Among patients with urachal adenocarcinoma, 7 received extended partial bladder resection. None of them had local recurrence. Patients with bladder adenocarcinoma mainly received partial bladder resection, with which 4 developed local recurrence at the primary site. The 5-year survival rate of urachal adenocarcinoma and bladder adenocarcinoma was 33.3% and 20.0%, respectively. One patient of bladder adenocarcinoma with skin and inguinal lymph node metastases and 2 patients of urachal adenocarcinoma with lung metastasis treated with chemotherapy and radiotherapy survived 24, 28 and 60 months, respectively. CONCLUSION: Extended partial bladder resection is the treatment of choice for urachal adenocarcinoma while radical cystectomy for bladder adenocarcinoma. Comprehensive therapy should be given to patients with metastatic or recurrent disease to improve survival.
UI - 11776665
AU - de Wit R
TI - [New developments in chemotherapy for metastasized bladder cancer]
SO - Ned Tijdschr Geneeskd 2001 Dec 15;145(50):2412-7
AD - Academisch Ziekenhuis, afd. Interne Oncologie, Postbus 5201, 3008 AE Rotterdam. email@example.com
Methotrexate vinblastine doxorubicin cisplatin (MVAC) has been the golden standard in the chemotherapy of metastasized bladder cancer for more than ten years. This regimen is particularly suitable for fit patients (WHO performance status 0 or 1) with a good renal function. This leads to an overall response in 40-57% of the patients and to a complete response in 13-19%. The median survival is about 15 months. Combination chemotherapy consisting of cisplatin and gemcitabine (GC) is a valuable alternative with a comparable effectiveness, but with the advantage of clearly less toxicity (neutropenic fever, mucositis, sepsis and mortality). The extra value of adding paclitaxel to this GC combination to improve the survival of this fit group of patients is currently being investigated. The value of the combination carboplatin-gemcitabine versus carboplatin-methotrexate-vinblastine as a palliative regimen with a favourable toxicity profile for the less fit patients is also currently under investigation.
UI - 11490207
AU - Koga F; Nagamatsu H; Ishimaru H; Mizuo T; Yoshida K
TI - Risk factors for the development of bladder transitional cell carcinoma following surgery for transitional cell carcinoma of the upper urinary tract.
SO - Urol Int 2001;67(2):135-41
AD - Department of Urology, Tokyo Rosai Hospital, Tokyo, Japan. firstname.lastname@example.org
To determine the risk factors for development of transitional cell carcinoma (TCC) of the bladder (BTCC) following surgery for TCC of the upper urinary tract (UUT-TCC) in patients without history of BTCC, 85 patients surgically treated for UUT-TCC (34 female, 51 male; median age 66, range 42-85 years) were reviewed retrospectively. The Cox proportional hazards model was used to assess the association of relevant clinicopathologic factors with BTCC-free survival in patients without a history of BTCC and TCC-specific survival in all. Median follow-up duration was 35 (range 1-193) months. Six patients (7%) had previous histories of BTCC, and 6 others (7%) had concurrent BTCC at the time of surgery for UUT-TCC. Of 70 patients who had no history of BTCC and underwent follow-up cystoscopy, 24 (34%) developed BTCC during follow-up after surgery. Univariate analysis identified female sex, postoperative systemic chemotherapy, and incomplete distal ureterectomy as significant risk factors for new development of BTCC. After multivariate analysis adjusted for age and pathological (p) T stage in the TNM classification, all three factors remained significant, with respective hazard ratios of 5.56 (95% confidence interval (CI), 1.99-15.6; p = 0.001), 3.19 (95% CI, 1.34-7.62; p = 0.009) and 2.99 (95% CI, 1.08-8.26; p = 0.03). Only pT stage was a significant independent risk factor for TCC-specific death. Female sex and postoperative systemic chemotherapy, as well as incomplete distal ureterectomy, are possible riks factors for development of BTCC following surgery for UUT-TCC. Copyright 2001 S. Karger AG, Basel
UI - 11796281
AU - Irie A; Iwamura M; Kadowaki K; Ohkawa A; Uchida T; Baba S
TI - Intravesical instillation of bacille Calmette-Guerin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter.
SO - Urology 2002 Jan;59(1):53-7
AD - Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
OBJECTIVES: To evaluate the therapeutic efficacy of bacille Calmette-Guerin (BCG) for carcinoma in situ (CIS) of the urothelium involving the upper urinary tract when the vaccine was administered by way of the bladder using vesicoureteral reflux created by a double-pigtail (DP) catheter. METHODS: Thirteen upper urinary tracts of 9 patients with cytologically diagnosed CIS, with concomitant bladder CIS in 4, were treated by intravesical BCG instillation. A DP catheter was placed retrogradely, and the appearance of vesicoureteral reflux was confirmed by cystography. BCG (1 to 2 mg/mL) in a volume sufficient to fill the renal caliceal system was administered into the bladder weekly for 6 weeks. The mean follow-up was 36 months (range 8 to 97). RESULTS: The voided urine cytology turned negative in all 9 patients at a mean of 86 days after the first administration of BCG. The voided urine cytology returned positive afterward in 3 patients, and positive cytology in the upper urinary tract was confirmed in 1 of 13 treated urinary tracts, which were successfully treated by another course of BCG therapy with the DP catheter. Minor adverse effects related to BCG and the DP catheter were seen in 5 patients. CONCLUSIONS: BCG therapy for the CIS involving the upper urinary tract using a DP catheter might have the potential to be an effective procedure preserving renal units and could be adopted not only as an imperative, but also as an elective, treatment option.
UI - 11174461
AU - Krupski T; Theodorescu D
TI - Orthotopic neobladder following cystectomy: indications, management, and outcomes.
SO - J Wound Ostomy Continence Nurs 2001 Jan;28(1):37-46
AD - Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
Gross painless hematuria often prompts patients to seek medical attention. For some persons, especially those aged 55 to 80 years, this hematuria will prove to be the result of bladder cancer. Patients found to have muscle-invasive disease commonly undergo radical cystectomy and urinary diversion. The decision about which urinary diversion will be best suited to the individual patient is complex and depends on multiple factors relating to the patient and the tumor as well as a clear understanding about the risks and benefits of each diversion. This article will discuss issues such as cancer control, preoperative and postoperative care, management of the condition at home, and quality of life associated with the various urinary diversion options, with a special emphasis on orthotopic neobladder reconstruction. Awareness of the special issues associated with this procedure is needed to safely counsel and care for patients with these forms of bladder substitution.
UI - 11780464
AU - Tong Q; Zeng F; Zheng L; Zhao J; Lu G
TI - Apoptosis inducing effects of arsenic trioxide on human bladder cancer cell line BIU-87.
SO - Chin Med J (Engl) 2001 Apr;114(4):402-6
AD - Department of Urology, Union Hospital, Tongji Medical College of Huazhong Science and Technology University, Wuhan 430022, China.
OBJECTIVE: To explore the apoptosis inducing effects of arsenic trioxide (As2O3) on human bladder cancer cells and elucidate possible mechanisms. METHODS: After treatment with As2O3, the growth inhibition rates of human bladder cancer cell line BIU-87 were studied by MTT and cell counts methods. DNA synthesis rates were detected by 3H-TdR assay. The morphological changes of cancer cells were observed by light and electronic microscopy and cell apoptosis rates were detected by TdT-mediated dUTP nick end labeling (TUNEL). bcl-2 gene expression of BIU-87 cells was observed by strept avidin-biotin complex (SABC) immunohistochemical method. RESULTS: As2O3 could effectively inhibit the growth of BIU-87 (P < 0.05), which were time and concentration dependent. The inhibition rate of 4.0 mumol/L As2O3 for DNA synthesis of cancer cells was 55.64% (P < 0.01). Partial cancer cells presented the characteristic morphological changes of apoptosis which depended on the time of exposure to drug (P < 0.05). bcl-2 expression of BIU-87 cells was decreased significantly (P < 0.05). CONCLUSION: As2O3 can significantly induce apoptosis in bladder cancer cells by down-regulating the expression of the bcl-2 gene and inhibiting DNA synthesis. This provides a potentially effective method for prevention and cure of human bladder cancer.
UI - 11747326
AU - Faithfull S; Corner J; Meyer L; Huddart R; Dearnaley D
TI - Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy.
SO - Br J Cancer 2001 Dec 14;85(12):1853-64
AD - Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, UK.
This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention focused on coping with symptoms, and provided continuity of care and telephone support. Further work is required to improve the management of patients during and after radiotherapy.
UI - 11826504
AU - Bagrova SG
TI - [Results of phase II clinical trial of cycloplatam in refractory solid tumors]
SO - Vopr Onkol 2001;47(6):752-6
AD - N.N. Blokhin Center for Oncology Research, Russian Academy of Medical Sciences, Moscow.
Cycloplatam, a new platinum derivative, evolved at N.S. Kurnakov Institute of General and Inorganic Chemistry in 1982, has been added to the arsenal of Russian cytostatic drugs. Having passed phase I trials, it was approved for treatment of pleural mesothelioma, ovarian carcinoma and multiple myeloma. Leukothrombocytopenia formation indicates toxicity-related limit of dosage. Phase II clinical trials are under way at the Center. They include treatment of solid tumors with cycloplatam alone in urinary bladder tumors, cervical carcinoma and malignant pleurites of various etiology as well as in combination with other cytostatics (carcinoma of the prostate, pleural mesothelioma and urinary bladder tumors). The drug may be recommended both for oral and intracavitary administration; side-effects may include moderate toxicity, chiefly, hematological one.
UI - 11834389
AU - Schips L; Augustin H; Zigeuner RE; Galle G; Habermann H; Trummer H;
TI - Pummer K; Hubmer G Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer?
SO - Urology 2002 Feb;59(2):220-3
AD - Department of Urology, University Hospital, Karl-Franzens University Graz, Graz, Austria.
OBJECTIVES: To assess the value of repeated transurethral resection (TUR) in patients with newly diagnosed superficial bladder cancer. METHODS: A second TUR was performed in 110 consecutive patients (24 women and 86 men) with newly diagnosed superficial bladder cancer. The mean age was 66 years (range 30 to 85). A second TUR was performed within 4 to 6 weeks after the initial TUR. After the first TUR, the pathologic stage was pTa in 31 patients (28%), pT1 in 76 (70%), and carcinoma in situ in 3 (2%). The pathologic records of the second TUR were reviewed and compared with the findings of the first operation. RESULTS: Cystoscopy before the second TUR was negative in 79 patients. Of these cases, 14 (17.7%) had cancer histologically. The second TUR was negative in 70 patients (63.6%). Twenty-two (20%) had residual cancer of the same stage, 9 (8.2%) had a lower stage, and 9 (8.2%) had a higher stage. Of 31 patients with Stage pTa and 76 patients with Stage pT1 at the first TUR, 19 (61.3%) and 51 (67.1%) had a negative second TUR, respectively. CONCLUSIONS: We recommend a second TUR for patients with superficial bladder cancer for several reasons. A negative second TUR provides important prognostic information. In addition, removal of residual cancer is achieved early. Finally, patients with pT1 G3 tumors are at high risk of residual, or even invasive, cancer and should be offered definitive therapy as early as possible.
UI - 11834391
AU - Pansadoro V; Emiliozzi P; de Paula F; Scarpone P; Pansadoro A; Sternberg
TI - CN Long-term follow-up of G3T1 transitional cell carcinoma of the bladder treated with intravesical bacille Calmette-Guerin: 18-year experience.
SO - Urology 2002 Feb;59(2):227-31
AD - Vincenzo Pansadoro Foundation, Rome, Italy.
OBJECTIVES: Immunotherapy with bacille Calmette-Guerin (BCG) has been proposed in the past decade as first-line treatment for high-grade superficial bladder cancer (G3T1). We report our 18-year experience in the treatment of patients with G3T1 bladder cancer. METHODS: From resection for superficial bladder cancer. Eighty-one patients (12%) had G3T1 tumors. All of these patients were treated with an innovative schedule of Pasteur strain BCG followed by maintenance BCG therapy. Treatment consisted of four cycles of 6 instillations per cycle of BCG. The first cycle was administered weekly x 6, the second was given every 2 weeks x 6, the third cycle was given monthly x 6, and the fourth was given every 3 months x 6 instillations. RESULTS: Sixty-nine patients (84%) completed at least the first two cycles. At a median follow-up of 76 months (range 30 to 197), the overall recurrence rate was 33% (27 of 81). The median time to recurrence was 20 months (range 5 to 128). Of these patients, 12 (15%) had progression at a median follow-up of 16 months (range 8 to 58). Cystectomy was required in 7 patients (8%). Death from disease occurred in 5 (6%) of 81 patients. One patient died of adenocarcinoma at the ureterosigmoidostomy site. Sixty patients (74%) were alive at a median follow-up of 79+ months (range 15 to 182). Of these, 56 (69%) were alive with a functioning bladder. CONCLUSIONS: Conservative treatment with BCG is a reasonable approach for patients with primary G3T1 transitional cell carcinoma of the bladder. The long-term results of BCG therapy are good. Cystectomy may not be justified as the therapy of choice in first-line treatment of high-grade superficial carcinoma of the bladder.
UI - 10792161
AU - Cooke PW; James ND; Ganesan R; Burton A; Young LS; Wallace DM
TI - Bcl-2 expression identifies patients with advanced bladder cancer treated by radiotherapy who benefit from neoadjuvant chemotherapy.
SO - BJU Int 2000 May;85(7):829-35
AD - Departments of Urology and Pathology, Queen Elizabeth Hospital, and CRC Institute for Cancer Studies, University of Birmingham, Birmingham, UK. email@example.com
OBJECTIVE: To assess the prognostic significance of Bcl-2 expression on the clinical outcome after radiotherapy for muscle-invasive bladder cancer, and to determine if it is possible to identify a subgroup of patients to whom neoadjuvant chemotherapy can be targeted to improve survival. PATIENTS AND METHODS: Immunohistochemical staining for Bcl-2 and p53 was performed on the tumours of 51 patients with stage T2-T4a NXM0 transitional cell carcinoma of the bladder who had been included in a randomized clinical trial of radiotherapy with or without neoadjuvant cisplatin. The association between positive staining and salvage cystectomy rate and overall survival was examined, with a median follow-up of 12 years. RESULTS: Bcl-2 and p53 expression was positive in 31 (61%) and 39 (76%) of the tumours, with no association between either, or with tumour stage or grade. There was no difference according to Bcl-2 positivity in the salvage cystectomy rate (P = 0.83) or survival (P = 0.68) for the 51 patients as a whole, but Bcl-2-negative patients receiving neoadjuvant cisplatin had a significantly better prognosis, with a median survival of 72 months compared to 17 months in Bcl-2-positive patients, and a 5-year survival rate of 55% (P = 0.03). CONCLUSIONS: Quantifying Bcl-2 in patients undergoing radiotherapy for advanced bladder cancer identifies those who may benefit from neoadjuvant chemotherapy. Further studies of other members of the Bcl-2 family and other proteins controlling both cell proliferation and apoptosis are warranted, to define the roles and the interactions between them that may contribute to oncogenesis and resistance to standard treatments. This may allow the targeting of specific treatments to patients known to be sensitive to them, and aid the future development of novel therapies for bladder cancer.
UI - 11069396
AU - Duggan B; Kelly J; Keane PF; Williamson K; Johnston SR
TI - Bcl-2 expression identifies patients with advanced bladder cancer treated by radiotherapy who benefit from neoadjuvant chemotherapy.
SO - BJU Int 2000 Oct;86(6):757
UI - 11832716
AU - Herr HW; Bochner BH; Dalbagni G; Donat SM; Reuter VE; Bajorin DF
TI - Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer.
SO - J Urol 2002 Mar;167(3):1295-8
AD - Departments of Urology (Genitourinary Oncology Service), Medicine and Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
PURPOSE: We postulate that the number of lymph nodes examined in cystectomy specimens can have an impact on the outcome of patients with bladder cancer. MATERIALS AND METHODS: We analyzed data on 322 patients with muscle invasive bladder cancer who underwent radical cystectomy and bilateral pelvic lymphadenectomy. We evaluated the associations of the number of lymph nodes identified by the pathologist in the surgical specimen with the local recurrence rate and survival outcome. RESULTS: Patients were divided into groups by lymph node status and the distribution of the number of lymph nodes examined. In stages pN0 and pN+ cases improved survival was associated with a greater number of lymph nodes examined. We determined that at least 9 lymph nodes should be studied to define lymph node status accurately. CONCLUSIONS: These results indicate that surgical resection and pathological assessment of an adequate number of lymph nodes in cystectomy specimens increases the likelihood of proper staging and impacts patient outcome. Such information is important not only for the therapy and prognosis of individuals, but also for identifying those who may benefit from adjuvant chemotherapy.
UI - 11832723
AU - Chang SS; Cookson MS; Hassan JM; Wells N; Smith JA Jr
TI - Routine postoperative intensive care monitoring is not necessary after radical cystectomy.
SO - J Urol 2002 Mar;167(3):1321-4
AD - Department of Urologic Surger, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
PURPOSE: Patients undergoing radical cystectomy have historically required intensive care monitoring in the perioperative period. We examined the postoperative care of these patients since the institution of a clinical care pathway with special attention to the need for intensive care unit admission. MATERIALS AND METHODS: We reviewed the records of 304 consecutive patients who underwent radical cystectomy and nature of postoperative care, American Society of Anesthesiologists score, estimated blood loss, transfusion requirement, hospital stay, perioperative minor complications, major complications, the mortality rate and urinary diversion type. RESULTS: Of the 304 patients 20 (6.5%) required intensive care unit monitoring during postoperative recovery and 18 were admitted directly to the intensive care unit postoperatively. Compared with the total population those admitted to the intensive care unit had increased hospital stay (p = 0.002), higher American Society of Anesthesiologists score (p <0.001), higher transfusion requirement (p = 0.001) and shorter operative time (p = 0.02). Patients who received blood transfusion and those with major complications were more likely to need intensive care unit care (p = 0.019 and <0.001, respectively). A single patient died who did not receive intensive care unit care. CONCLUSIONS: Our clinical care pathway outlines postoperative care on the regular urology floor for patients who undergo radical cystectomy. This policy has been safe and efficacious. We believe that admission to the intensive care unit should only be done in select cases.
UI - 11832724
AU - Soulie M; Straub M; Game X; Seguin P; De Petriconi R; Plante P; Hautmann
TI - RE A multicenter study of the morbidity of radical cystectomy in select elderly patients with bladder cancer.
SO - J Urol 2002 Mar;167(3):1325-8
AD - Department of Urologic Surgery and Andrology, Rangueil University Hospital, Toulouse, France.
PURPOSE: We evaluated the morbidity of radical cystectomy for invasive bladder cancer in select patients older than 75 years using recent data from 2 academic hospitals. MATERIALS AND METHODS: We analyzed 73 radical 89 years old (median age 79.3). Cases were categorized according to the American Society of Anesthesiologists classification with a score of 2 in 41, 3 in 30 and 4 in 2. External urinary diversion was performed in 51 cases and an ileal neobladder was constructed in 22. We evaluated the incidence and type of complications, clinical outcome, and postoperative care unit and hospital stay. Statistical analysis was done using the chi-square and Student t tests. RESULTS: Median operative time was 263 minutes (range 95 to 451). The perioperative mortality rate was 2.7%. The intraoperative, early and late postoperative complication rates were 38.4%, 46.5% and 16.4%, respectively. Three reoperations (4.1%) were necessary. The most common early complications were pyelonephritis in 12.3% of cases, disorientation in 10.9%, pneumonia in 8.2% and prolonged ileus in 12.3%. The most common late complications were ureteroileal anastomotic stenosis in 5 cases and hernia in 3. Median postoperative care unit and hospital stays were 12 and 34 days, respectively. At a median followup of 14.4 months (range 6 to 74) the overall mortality rate was 31.5%. Hospital stay was significantly higher in patients with complications. The incidence of complications was similar in the 2 groups. CONCLUSIONS: These data support the aggressive surgical management of bladder cancer in select elderly patients. A rigorous multidisciplinary team approach can provide acceptable perioperative morbidity.
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