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Informations: New researches about the surgical therapy of bladder cancer
Transmis par : Admin actif Lundi, 21 Mai 2007 @ 20:26
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(AUA 2007, Anaheim, CA, May 20, 2007) – A podium session moderated from Robert R. Bahnson and Michael A O’Donnell discussed new studies about the surgical therapy of urothelian carcinomas. one highlight of this session was the studies about the laparoscopic and robotic radical cystectomy of the bladder. Some videos in this article are available.
Video is available here
Aaron Lentz, from Chapel Hill, NC, reported in their study that in patients undergoing cystectomy for bladder cancer, married individuals appear to have improved pre-operative laboratory variables, shorter hospitalization, and improved pathological outcomes vs. unmarried patients in our case series. These findings may support the evidence (observed in other tumor types and other disease states) that married persons present earlier than unmarried individuals, and this may help explain the improved survival outcomes that have been observed in married patients with bladder cancer.
Video is available here
A nonrandomized inter-institutional comparison from Bern, Switzerland and Cleveland, OH, reported that the extended pelvic lymphnode dissection is associated with lower recurrence rates in patients after radical cystectomy. Nivedita Dhar explained that the compare and evaluate the rates of recurrence (local and/or systemic) for patients with stage pT2pN0-2 and pT3pN0-2 urothelial carcinoma of the bladder with limited pelvic lymph node dissection (PLND) at Cleveland Clinic (CCF) or with an extended PLND at University of Bern (Bern). Recognizing the inherent limitations of a retrospective two institution comparison, the results suggest that the more extended the PLND, the more likely positive nodes are found and if so, a meticulous extended PLND may reduce the probability of local and/or distant recurrence when compared to a limited PLND.
Video is available here
The researcher group of Ulm, Germany, reported from Georg Bartsch, visualized a study about prostate cancer in cystectomy speciments of patients with bladder cancer. The results of this study explained that in 23 cases the patients had a definite PCA therapy before radical cystectomy, while in 244 cases PCA was diagnosed incidentally in the cystectomy specimen. In these concurrent PCA-cases the median and medium serum-PSA level was 2.3 ng/ml and 4.6 ng/ml (Range 0.3 -77.4 ng/ml), while in those patients who had no PCA, the median and medium serum-PSA level was 1.3 ng/ml and 2.0 ng/ml (range 0.1 - 51.7 ng/ml). The detection rate of PCA increased by optimizing the histopathologic work-up from 7.7% to 33.4%. The rate of PCA with Gleason-score >6 decreased from 15.6 % to 10.4 %, while the rate of locally advanced PCA decreased from 31.3 % to 11.8 %. The rate of significant PCA changed from 40.6 % to 31.6 %. The incidence of PCA in the early series was: < 50y: 2%, 50-59y: 4%, 60-69y: 7%, 70y+: 18%. These incidences increased in the current series: <50y: 8%, 50-59y: 28%, 60-69y: 34%, 70y+: 41%. The rate of postoperative PSA-progression in the complete series was only 1%. only one patient died from progressing PCA (Gleason-Score 10). Even with intensified histopathologic work-up, the incidence of prostate cancer remains lower than expected from the literature. In contrast to radical prostatectomy the cure rate of prostate cancer by radical cystoprostatectomy is extremely high. This raises the question, whether the definition of a ,,signficant“ PCA should be limited to cases with non organ-confined or Gleason 8-10 tumors.
Video is available here
Clayton S Lau, Duarte, CA, talk about their study of the laparoscopic and robotic assisted laparoscopic cystectomy and urinary diversion: the City of Hope experience. They retrospectively reviewed the charts of 111 patients that have undergone either laparoscopic or robotic assisted laparoscopic cystectomy and urinary diversion at our institution and examine multiple clinical and pathologic variables. Between 5/2001 and 10/2006 111 total cases were done, 51 laparoscopically and 60 robotic assisted laparoscopic. Eighteen of these were salvage cystectomies. The charts of these patients were retrospectively reviewed. Preoperative characteristics including gender, clinical stage, and indications for surgery were analyzed. Postoperatively EBL, conversion rate, number of lymph nodes removed, pathologic stage, positive margin rate, port site metastasis rate, and complication rates were evaluated. Ninety men and twenty one women underwent radical cystectomy via laparoscopic or robot assisted laparoscopic approach. The most common indication was high grade urothelial bladder cancer (n=98, 88,3%). Average EBL for the laparoscopic approach was 556,6ml (100-2000ml), while it was 375 (100-1500ml) in the robotic assisted laparoscopic group. The average lymph nodes removed in the laparoscopic and robotic assisted laparoscopic group was 16,1 (2-42) and 20,7 (2-47) respectively. There were positive margins in 6 (5,4%) patients. Urinary diversions were done via a mini-laparotomy. Average hospitalization was 15,1 and 12,9 days respectively in the laparoscopic and robotic assisted laparoscopic groups. Complication rates were 31,3% and 33,3% in the laparoscopic and robotic assisted laparoscopic group respectively. No port site metastasis reported. This is the largest single institional series of laparoscopic and robotic assisted laparoscopic cystectomies. It can be done safely, while postoperative recovery and oncologic outcomes appear to be similar to open surgery. An extended lymph node dissection can be accomplished via both minimally invasive approaches. However, controlled clinical trials and comparisons from high volume centers are needed.
Video is available here
Gerald J Wang from New York, NY, reported about their study of the prospective comparison of perioperative and early pathologic outcomes of the robotic versus open radical cystectomy. Their initialexperience with robotic-assisted RC suggests potential advantages compared to the standard open approach. Although operative duration was greater in the robotic group, blood loss, transfusion requirement, time to regular diet, and hospital stay were all decreased compared to the open cohort. The robotic method also demonstrated comparable early pathologic outcomes, with no difference in margin status or total number of lymph nodes removed. Long-term functional and oncologic outcomes are needed to better define the role of robotic-assisted RC in the surgical management of bladder cancer.
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