ASCO GU 2017: Optimizing Outcomes in Muscle-Invasive and Metastatic Bladder Cancer - Surgeon’s Perspective - Session Highlights
Orlando, Florida USA (UroToday.com) Matthew Tollefson, Mayo Clinic, discussed a case of a 62 year old man with 3cm bladder tumor HG pT1 tumor with micropapillary features. Given the variant histology, there are concerns regarding aggressiveness and patients may choose from intravesical treatments to neoadjuvant chemotherapy followed by radical cystectomy to upfront radical cystectomy. This patient tolerated 4 cycles of GC and underwent uneventful robotic radical cystectomy. Intraoperative blood transfusions are associated with significant costs, transfusion reactions, risk of infections and increased risk of bladder cancer-specific mortality. Limiting the use of transfusions and meticulous dissection, regardless of open or robotic approach, is paramount to decrease morbidity and mortality associated with radical cystectomy. Moreover, limiting perioperative fluid administration has been associated with improved outcomes. Tranexamic acid is an analog being currently investigated to limit transfusion use. This patient had pT3N0M0 disease with follow-up as determined by the NCCN guidelines with 2 of 3 studies showing improved survival benefit of surveillance following treatment.
Presenter: Eugene Lee, University of Kansas Medical Center
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX
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