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Cystoscopic-assisted partial cystectomy: description of technique and results.

Gofrit ON, Shapiro A, Katz R, Duvdevani M, Yutkin V, Landau EH, Zorn KC, Hidas G, Pode D - Res Rep Urol (2014)

Bottom Line: The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088).Overall, disease-specific and disease-free survival rates were similar.Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.

ABSTRACT

Background: Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder.

Methods: During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy.

Results: Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar.

Conclusion: The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curves.
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f2-rru-6-139: Kaplan–Meier survival curves.

Mentions: The oncological results for the entire cohort are presented in Figure 2. The 5-year overall, disease-specific, and recurrence (local and systemic)-free survival rates were 55%, 67%, and 42%, respectively. Local (intravesical) recurrence was treated with repeated transurethral resection with or without adjuvant bacillus Calmette-Guerin (six patients in the standard partial cystectomy group and none in the CAPC group) or by radical cystectomy (one patient in each group). Systemic recurrence was treated by chemotherapy in three patients in the standard partial cystectomy group and by supportive care in a total of three patients. Table 2 compares the oncological results obtained using the traditional and novel methods. Overall, disease-specific and disease-free survival rates were similar. Local recurrence-free survival was marginally better using CAPC, which resulted in only one local failure 9 months after partial cystectomy. Using standard partial cystectomy, there were seven local failures. This translates to a 5-year local recurrence-free survival of 0.8 for the patients treated using CAPC and 0.426 for those treated using standard partial cystectomy (P=0.088).


Cystoscopic-assisted partial cystectomy: description of technique and results.

Gofrit ON, Shapiro A, Katz R, Duvdevani M, Yutkin V, Landau EH, Zorn KC, Hidas G, Pode D - Res Rep Urol (2014)

Kaplan–Meier survival curves.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216031&req=5

f2-rru-6-139: Kaplan–Meier survival curves.
Mentions: The oncological results for the entire cohort are presented in Figure 2. The 5-year overall, disease-specific, and recurrence (local and systemic)-free survival rates were 55%, 67%, and 42%, respectively. Local (intravesical) recurrence was treated with repeated transurethral resection with or without adjuvant bacillus Calmette-Guerin (six patients in the standard partial cystectomy group and none in the CAPC group) or by radical cystectomy (one patient in each group). Systemic recurrence was treated by chemotherapy in three patients in the standard partial cystectomy group and by supportive care in a total of three patients. Table 2 compares the oncological results obtained using the traditional and novel methods. Overall, disease-specific and disease-free survival rates were similar. Local recurrence-free survival was marginally better using CAPC, which resulted in only one local failure 9 months after partial cystectomy. Using standard partial cystectomy, there were seven local failures. This translates to a 5-year local recurrence-free survival of 0.8 for the patients treated using CAPC and 0.426 for those treated using standard partial cystectomy (P=0.088).

Bottom Line: The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088).Overall, disease-specific and disease-free survival rates were similar.Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.

ABSTRACT

Background: Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder.

Methods: During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy.

Results: Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar.

Conclusion: The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.

No MeSH data available.


Related in: MedlinePlus