sparing cystectomy in patients with transitional-cell carcinoma of the urinary bladder
استئصال المثانة الاستبقائي لدى مرضى سرطان الخلايا الانتقالية في المثانة البولية
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Abstract
Objective: to study the results of sparing cystectomy in patients with urinary bladder cancer (UBC).
Subjects and methods. The study has covered 82 patients with transitional-cell UBC (T1-4aN0M0) who received radiotherapy (RT) and thenunderwent radical cystectomy at the N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, in 1980 to2007. Among them there were 76 (92.7%) males and 6 (7.3%) females. The median age was 55.2±10.8 years. Superficial (T1) and inva-sive (Т2—4а) carcinomas were detected in 33 (40.2%) and 49 (59.8%) patients, respectively. Category N+ was identified in 3 (3.7%) patients.All the patients received RT to the bladder area (median total focal dose (TFD) 56±12.3 Gy) and regional metastatic zones (median TFD40.0±0.0 Gy). A full effect of irradiation was achieved in 44 (53.7%) patients, of whom 41 (93.2%) developed local relapses. All the 82patients underwent radical cystectomy: that with ureterostomy in 28 (34.1%) cases, Bricker’s operation in 45 (54.4%), Studer’s operationin 4 (4.9%), and rectal urinary bladder in 5 (6.1%). The median follow-up was 32.7±31.9 months.
Results. The median interval between RT and cystectomy was 12.5±5.1 months; the median time of surgery was 360 (60—480) min; themedian blood loss was 1515.2±1227.8 ml. Intraoperative and postoperative complications developed in 10 (12.2%) and 40 (48.6%)patients, respectively. Repeated operations were performed in 7 (8.4%) cases. Mortality was 4.9%. A urinary derivation technique failed toaffect the incidence of complications and the rates of mortality (p > 0.05). Histological studies revealed transitional-cell carcinoma in thedistant specimens in 80 (97.6%) cases. Recurrences developed in 40 (48.8%) of the 82 patients following an average of 32.9 (1—150)months of cystectomy: local relapses in 5 (6.1%) cases; distant metastases in 29 (35.4%); a local relapse and distant metastases in 5 (6.1%);urethral recurrence in 1 (1.2%) patient. Five-year overall, specific, and relapse-free survivals were 43.9 (median 48.4±10.5 months), 48.5(59.9±9.3 months), and 42.8% (47.4±9.6 months), respectively.
Conclusion. Sparing cystectomy with any urinary derivation technique is associated with the acceptable frequency of complications and pro-vides fair long-term results in patients who show no complete effect or who have a local UBC relapse after RT.
الهدف: دراسة نتائج استئصال المثانة الإنقاذي لدى مرضى سرطان المثانة البولية (UBC).
المرضى والطرائق: شملت الدراسة 82 مريضاً مصاباً بسرطان المثانة البولية ذي الخلايا الانتقالية (T1-4aN0M0) ممن تلقوا علاجاً إشعاعياً (RT) ثم خضعوا لاستئصال المثانة الجذري في مركز ن. ن. بلوخين الروسي لأبحاث السرطان، التابع للأكاديمية الروسية للعلوم الطبية، في الفترة من عام 1980 إلى 2007. وكان من بينهم 76 (
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matveyev2014onkourologisparing
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| Authors | ;V. B. Matveyev;M. I. Volkova;K. M. Figurin;M. V. Peters |
| Journal | supportive care in cancer |
| Year | 2014 |
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