Ureteral carcinoma in situ at radical cystectomy: Does the margin matter? Journal Article
| Authors: | Silver, D. A.; Stroumbakis, N.; Russo, P.; Fair, W. R.; Herr, H. W. |
| Article Title: | Ureteral carcinoma in situ at radical cystectomy: Does the margin matter? |
| Abstract: | Purpose: The clinical impact of ureteral carcinoma in situ identified at the time of radical cystectomy for bladder cancer has been poorly studied. We discuss our experience with this clinical problem in the context of published reports. Materials and Methods: A total of 31 patients with concomitant ureteral carcinoma in situ was retrospectively identified among 401 consecutive radical cystectomies. End points analyzed included positive urinary cytology, upper tract recurrence of carcinoma and cancer specific survival. Results: Ureteral margins were positive in 21 patients and negative in 10. Among 30 patients in whom it was performed frozen section failed to detect carcinoma in situ in 5 (16.6%) and sequential ureteral resection did not result in a negative margin in 15 (50%). In 3 patients upper tract carcinoma recurred at the anastomosis (1) and renal pelvis/ureter (2) at a median of 51 months (mean 49, range 36 to 59) following cystectomy. Positive cytology and upper tract carcinoma recurrence were not significantly associated with ureteral margin status, clinical or pathological bladder tumor stage or prior bacillus Calmette Guerin treatment. Median followup was 22.9 months (mean 31.8, range 2.0 to 74.2), during which 7 of the 31 patients died of metastatic bladder cancer. Conclusions: Concomitant ureteral carcinoma in situ is uncommon, and is rarely associated with local morbidity. It appears to confer increased risk for upper tract carcinoma recurrence, irrespective of margin status. In our experience upper tract carcinoma recurrence is heralded by positive cytology and generally appears only with protracted followup. Prognosis appears to be determined by the bladder tumor. Given the lack of morbidity and mortality attributable to concomitant ureteral carcinoma in situ, and the limited ability of frozen section examination to assist in its extirpation, the value of intraoperative identification of concomitant ureteral carcinoma in situ is questionable and expectant management is advised. |
| Keywords: | adult; clinical article; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; human cell; histopathology; cancer recurrence; follow-up studies; neoplasm recurrence, local; urinary bladder neoplasms; carcinoma in situ; cystectomy; ureteral neoplasms; ureter; ureter carcinoma; frozen section; neoplasms, multiple primary; humans; prognosis; human; male; female; priority journal; article |
| Journal Title: | Journal of Urology |
| Volume: | 158 |
| Issue: | 3 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 1997-09-01 |
| Start Page: | 768 |
| End Page: | 771 |
| Language: | English |
| DOI: | 10.1016/s0022-5347(01)64312-x |
| PUBMED: | 9258077 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 17 March 2017 -- Source: Scopus |
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