ANAHEIM, CA (UroToday.com) - The group from Chapel Hill, NC presented data (#333) showing that married patients with bladder cancer tend to have better outcomes after radical cystectomy including decreased hospital stay and also, surprisingly, lower pathologic stages. Reasons postulated for this included better support resulting in quicker presentation to physicians once symptoms are present. The same groups also presented data (#344) where they compared the performance of the ‘Bricker’ and ‘Wallace’ type ureterointestinal anastamoses in 186 patients undergoing urinary diversion. While no strictures were seen with the Wallace technique, the stricture rate was 5.2% with the Bricker technique and strictures were detected a median of 9 months after surgery, with the majority on the left side (66%).

Dhar from Switzerland (#334) presented a provocative study where the patients undergoing radical cystectomy at the Cleveland Clinic, where the practice is to perform a limited node dissection were compared with those undergoing surgery at University of Bern, where the practice is to perform an extended node dissection up to the common iliac vessels. Both groups were treated from 1987 to 2000. The median nodes removed in the CC patients (385 total) was 12 with 7.5% node positivity in pT2 patients and 21% in pT3 patients. In the Bern group a median of 22 nodes were removed, resulting in 16% node positivity in pT2 patients and 34% in pT3 patients. Overall there were about 93% recurrences in the patients treated at CC compared to 65% in those treated at Bern, suggesting that the patients who are treated with an extended template fare better. This abstract received heavy discussion with most agreeing that an extended node dissection should now be considered standard of care.

Hauttmann’s group (#335) presented data showing an increased incidence of prostate cancer in patients who underwent radical cystectomy in the time period from 1995 to 2006 compared to 1986 to 1994. This was seen both in young patients (under 50, incidence up from 2% to 9.8%) as well as older patients (over 70, incidence up from 20% to 44%). More importantly, many of these cancers were ‘clinically significant’. Dicussion which followed suggested that this data be used in the argument against prostate sparing cystectomy, especially in young patients.

There were 2 papers presented on the comparison of robotic and laparoscopic radical cystectomy with traditional open surgery. The group from City of Hope (#336) showed a margin positive rate of 5.7% in the 98 patients treated with robotic/laparoscopic technique while the group from New York (#337) demonstrated a 9% positive margin rate in 33 patients who underwent robotic cystectomy. In discussions that followed, Dr Skinner and other experts brought up the point that while hospital stays might be shorter and blood loss slightly lower with the robotic technique, this is accompanied with a huge downside with margin rates reported since, in bladder cancer, a positive margin is a fatal occurrence and rates should be less than 2-3% in most series.

Two other abstracts focused on transurethral resection of bladder tumors (TURBT). The Brazilian study (#338) studied the incidence of bladder perforation detected by post TUR contrast instillation and detected a 56% incidence on non-clinically significant perforations. This was not different from prior studies, and discussants did feel that it reflected real world occurrence. The Korean group (#339) presented impressive data on bladder preservation with layer resection of cT2 tumors, where they performed successive resection of the muscle layer until perivesical adipose tissue was sampled. They studied 90 patients (79 with high grade T2 and 11 with low grade T2 disease) and were able to follow 80 patients in a conservative manner. In all 27 patients developed a recurrence but only 4 progressed and required cystectomy. Overall the recurrence free survival rate at 5 years was 64% and disease specific survival was 85.9% suggesting that this technique might be worth evaluating. Discussants did caution against adopting this method without strict adherence to oncologic principles and patient selection, since factors such as CIS, re-TUR, etc can negative affect patient outcome.

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

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