Ureteral Carcinoma in Situ at Radical Cystectomy: Does the Margin Matter?

Silver, David; Stroumbakis, Nicholas; Russo, Paul; Fair, William R.; Herr, Harry W.

doi:10.1016/s0022-5347(01)64312-x

Cited by 47 publications

(55 citation statements)

References 11 publications

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“…However, available data suggest such incidences to be between 8 and 20%, which is similar to our result of 13.6% (3 of 22) [8][9][10] . These fi gures for upper urinary tract recurrences are relatively higher than the reported overall incidences (2.4-4.5%) of upper urinary tract recurrences after radical cystectomy in general [5,9,[12][13][14] . Contrary to the general assumption that the presence of carcinoma at the ureteral margin may contribute to increasing the risk of upper tract recurrences, none of the 5 patients (0%) who had CIS at the ureteral margin later developed upper tract recurrence in our series.…”

Section: Discussionsupporting

confidence: 92%

“…And, 2 of 3 patients who later demonstrated upper tract recurrence initially also had bladder CIS (p = 0.197). As for TCC involving the prostatic urethra which has been mentioned previously as a predictive factor for upper tract recurrence and poor prognosis, no upper tract recurrence was observed among the 7 patients with such a feature [8,9,11] .…”

Section: Resultsmentioning

confidence: 70%

“…Published reports indicate that up to 57% of patients who undergo radical cystectomy have unsuspected involvement of cancer [1,2,6,7,9] . Looking at the results of the present study, CIS was detected at the ureteral margin resected intraoperatively in only 5 of 115 patients (4.3%).…”

Section: Discussionmentioning

confidence: 99%

“…Urologists have historically resected positive margins to effect clearance of all documented cancer, assuming that this would provide better long-term local disease control including prevention of upper tract recurrence. Although such a viewpoint may sound logical, past studies have, in fact, failed to demonstrate that clearing the ureteral margins at the time of cystectomy provides any long-term benefi t [6][7][8][9] . In re-…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Significance of Cancer Involvement at the Ureteral Margin Detected on Routine Frozen Section Analysis during Radical Cystectomy

Lee

Byun²,

Hong³

et al. 2006

Urol Int

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Introduction: We investigated the clinical significance of preoperatively-unsuspected ureteral involvement of cancer detected on intraoperative frozen section analysis of ureteral margins during radical cystectomy. Patients and Methods: We performed a retrospective study of 115 patients who received radical cystectomy for locally-advanced but node-negative transitional cell carcinoma of the bladder between 1995 and 2002 by reviewing their records. Results: Of 115 total patients, 5 (4.3%) demonstrated carcinoma in situ at the ureteral margin with 2 of 5 having a positive margin on final pathologic analysis. Meanwhile, only 3 of 115 total patients (2.6%) later showed upper urinary tract recurrence at a median interval of 30 months after cystectomy. And all 3 patients had intramural or juxtavesical ureter involvement of disease (p = 0.006), while not demonstrating carcinoma in situ in ureteral margins resected during cystectomy. On multivariate analysis, only the stage and grade of bladder cancer along with pathologic feature of vascular invasion were observed to be independent prognostic predictors of disease-specific survival. Conclusions: Cancer involvement of the distal ureteral margin detected through intraoperative frozen section analysis may not be a significant factor regarding upper tract recurrence and survival of patients with locally-advanced bladder cancer after radical cystectomy. Upper tract recurrence may be more prone to occur in patients with cancer involvement at the intramural or juxtavesical ureter.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Significance of Cancer Involvement at the Ureteral Margin Detected on Routine Frozen Section Analysis during Radical Cystectomy

Lee

Byun²,

Hong³

et al. 2006

Urol Int

View full text Add to dashboard Cite

show abstract

“…Risk factors for upper urinary tract recurrence have been established as: history of diffuse CIS, multifocal tumour, intramural ureteral involvement with CIS, prior ureteral tumour, prostatic involvement and urethral involvement. [4][5][6][7] The ureteral FS does not appear to add any independent predictive ability over these established factors for future upper urinary tract recurrences. In addition, with its low positive predictive value, FS has a tendency to overestimate disease at the ureteral margin.…”

Section: Discussionmentioning

confidence: 87%