We reviewed the pathology findings of consecutive radical cystectomies in women performed at our institution over a 20-year period. After excluding women with non-bladder primary malignancies (e.g. urachal, urethral, other sites of origin) and those with absent reproductive organs at cystectomy, we found that 19 (15%) out of 123 women had reproductive organ (RO) involvement by bladder cancer. However, only 5 (4%) were specifically found to have ovarian involvement. Locally advanced disease (≥ pT3) and lymphovascular invasion (LVI) were significantly associated with increased risk of RO involvement. All women with ovarian involvement had locally advanced disease and lymphovascular invasion (LVI).
In our study, we found that 41% of women had extravesical disease, at least 24% had nodal metastases, and 15% had at least one reproductive organ involved by bladder cancer, which was predominantly uterine/cervical involvement. Given these findings, we caution against routinely performing a complete genital-sparing cystectomy outside of the highly select patient. In contrast, the risk of ovarian involvement in this study was very low and only evident in women with extravesical disease, LVI, and positive margins. Given the mounting evidence showing functional benefits of ovary-sparing surgery, the low rate of ovarian involvement by organ-confined bladder cancer, and the adaptation of ovary-sparing procedures by gynecologic oncologic surgeons, we recommend having an informed discussion with women of all ages regarding the risks and benefits of sparing the ovaries during radical cystectomy for bladder cancer. Lastly, our study also indirectly supports standardization of reporting LVI in TUR specimens by pathologists, which recently has been advocated for based on strong evidence for its prognostic value.6
Written by: Benjamin L Taylor, MD, Department of Urology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY and Francesca Khani, MD, Assistant Professor of Pathology & Laboratory Medicine, Assistant Professor of Pathology in Urology, Weill Cornell Medicine, Department of Pathology & Laboratory Medicine, New York, NY 10065
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