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

Abstract

No AccessJournal of UrologyClinical Urology: Original Articles1 Sep 1997Ureteral Carcinoma in Situ at Radical Cystectomy: Does the Margin Matter? David A. Silver, Nicholas Stroumbakis, Paul Russo, William R. Fair, and Harry W. Herr David A. SilverDavid A. Silver More articles by this author , Nicholas StroumbakisNicholas Stroumbakis More articles by this author , Paul RussoPaul Russo More articles by this author , William R. FairWilliam R. Fair More articles by this author , and Harry W. HerrHarry W. Herr More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64312-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The clinical impact of ureteral carcinoma in situ identified at the time of radical cystectomy for bladder cancer has been poorly studied. We discuss our experience with this clinical problem in the context of published reports. Materials and Methods: A total of 31 patients with concomitant ureteral carcinoma in situ was retrospectively identified among 401 consecutive radical cystectomies. End points analyzed included positive urinary cytology, upper tract recurrence of carcinoma and cancer specific survival. Results: Ureteral margins were positive in 21 patients and negative in 10. Among 30 patients in whom it was performed frozen section failed to detect carcinoma in situ in 5 (16.6%) and sequential ureteral resection did not result in a negative margin in 15 (50%). In 3 patients upper tract carcinoma recurred at the anastomosis (1) and renal pelvis/ureter (2) at a median of 51 months (mean 49, range 36 to 59) following cystectomy. Positive cytology and upper tract carcinoma recurrence were not significantly associated with ureteral margin status, clinical or pathological bladder tumor stage or prior bacillus Calmette Guerin treatment. Median followup was 22.9 months (mean 31.8, range 2.0 to 74.2), during which 7 of the 31 patients died of metastatic bladder cancer. Conclusions: Concomitant ureteral carcinoma in situ is uncommon, and is rarely associated with local morbidity. It appears to confer increased risk for upper tract carcinoma recurrence, irrespective of margin status. In our experience upper tract carcinoma recurrence is heralded by positive cytology and generally appears only with protracted followup. Prognosis appears to be determined by the bladder tumor. Given the lack of morbidity and mortality attributable to concomitant ureteral carcinoma in situ, and the limited ability of frozen section examination to assist in its extirpation, the value of intraoperative identification of concomitant ureteral carcinoma in situ is questionable and expectant management is advised. References 1 : Experiences with ureteral carcinoma in situ detected during operations for vesical neoplasm.. J. Urol.1967; 97: 679. 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Abstract, Google Scholar From the Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byWhalen M, RiChard J, Ghandour R, Lipsky M, Piecuch M, Benson M, Nieder A, DeCastro G and McKiernan J (2015) Lessons Learned from Routine Intraoperative Ureteral Margin Frozen Sections during Radical CystectomyUrology Practice, VOL. 2, NO. 2, (90-95), Online publication date: 1-Mar-2015.Picozzi S, Ricci C, Gaeta M, Ratti D, Macchi A, Casellato S, Bozzini G and Carmignani L (2012) Upper Urinary Tract Recurrence Following Radical Cystectomy for Bladder Cancer: A Meta-Analysis on 13,185 PatientsJournal of Urology, VOL. 188, NO. 6, (2046-2054), Online publication date: 1-Dec-2012.Tollefson M, Blute M, Farmer S and Frank I (2009) Significance of Distal Ureteral Margin at Radical Cystectomy for Urothelial CarcinomaJournal of Urology, VOL. 183, NO. 1, (81-86), Online publication date: 1-Jan-2010.Schumacher M, Scholz M, Weise E, Fleischmann A, Thalmann G and Studer U (2018) Is There an Indication for Frozen Section Examination of the Ureteral Margins During Cystectomy for Transitional Cell Carcinoma of the Bladder?Journal of Urology, VOL. 176, NO. 6, (2409-2413), Online publication date: 1-Dec-2006.Raj G, Bochner B, Serio A, Vickers A, Donat S, Herr H, Lin O and Dalbagni G (2018) Natural History of Positive Urinary Cytology After Radical CystectomyJournal of Urology, VOL. 176, NO. 5, (2000-2005), Online publication date: 1-Nov-2006.YOSSEPOWITCH O, DALBAGNI G, GOLIJANIN D, DONAT S, BOCHNER B, HERR H, FAIR W and RUSSO P (2018) Orthotopic Urinary Diversion After Cystectomy For Bladder Cancer: Implications For Cancer Control And Patterns Of Disease RecurrenceJournal of Urology, VOL. 169, NO. 1, (177-181), Online publication date: 1-Jan-2003.DONAT S, WEI D, McGUIRE M and HERR H (2018) THE EFFICACY OF TRANSURETHRAL BIOPSY FOR PREDICTING THE LONG-TERM CLINICAL IMPACT OF PROSTATIC INVASIVE BLADDER CANCERJournal of Urology, VOL. 165, NO. 5, (1580-1584), Online publication date: 1-May-2001. Volume 158Issue 3September 1997Page: 768-771 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information David A. Silver More articles by this author Nicholas Stroumbakis More articles by this author Paul Russo More articles by this author William R. Fair More articles by this author Harry W. Herr More articles by this author Expand All Advertisement PDF downloadLoading ...