ANAHEIM, CA (UroToday.com) - Dr Donald G. Skinner gave the John K. Lattimer Lecture at the today’s plenary session. Himself an icon in the urologic world, Dr Skinner presented ‘Lessons learned from 36 years of experience’ in the management of muscle invasive bladder cancer. In his view, paramount among the requirements for successful treatment of patients is excellent surgical technique. Dr Skinner cautioned against surgical indiscretions and reminded the audience that a positive margin during radical cystectomy is a fatal event. Citing his center’s experience with 1591 patients, he noted that 44% of patients with high grade T1 disease are upstaged, as are 54% of patients with high grade T2 disease. In his experience, extended pelvic node dissection results in a cure in roughly 20% of patients with node positive disease. He reminded the audience that the survival of patients is improved with an increase in extent of node dissection and also that low volume centers have higher positive margin rates (14%) compared to high volume centers. Discussing chemotherapy, Dr Skinner cited the MD Anderson Cancer Center experience which demonstrates that patients can receive pre-operative as well as post-operative chemotherapy with equal efficacy. He advocated better selection of patients for chemotherapy based on well defined factors such as pre-operative hydronephrosis, presence of LVI, small cell carcinoma or for post-operative factors such as node positive disease or recognition of variant histology. As a final ‘lesson learned’ Dr Skinner cautioned that chemotherapy is no substitute for quality surgery and cannot be used to ‘cover errors’ in surgery.

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Written by Ashish M. Kamat, a Contributing Editor with UroToday.

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