scholarly journals Gynecological organ involvement at robot-assisted radical cystectomy in females: Is anterior exenteration necessary?

2018 ◽  
Vol 12 (9) ◽  
pp. E398-402 ◽  
Author(s):  
Michelle Whittum ◽  
Ahmed Aly Hussein ◽  
Youssef E. Ahmed ◽  
Hijab Khan ◽  
Collin Krasowski ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Bladder Tumour ◽  
Organ Involvement ◽  
Robot Assisted ◽  
Female Patients ◽  
Kaplan Meier ◽  
Tumour Location ◽  
Variant Histology ◽  
Multifocal Disease ◽  
Organ Invasion

Introduction: We aimed to investigate patient and disease variables associated with gynecological organ invasion in females with bladder cancer at the time of robot-assisted radical cystectomy (RARC).Methods: We conducted a retrospective review of female patients who underwent robot-assisted anterior pelvic exenteration (RAAE) between 2005 and 2016. Patients were divided into two groups: those with gynecological organ involvement at RAAE and those without. Data were reviewed for perioperative and pathological outcomes. Kaplan-Meier method was used to depict survival outcomes. Multivariable stepwise regression analysis was performed to identify predictors of gynecological organ involvement.Results: A total of 118 female patients were identified; 17 (14%) showed evidence of gynecological organ invasion at RAAE. Patients with gynecological organ invasion had more lymphovascular invasion at transurethral resection of bladder tumour (TURBT) (82% vs. 46%; p=0.006), trigonal tumours at TURBT (59% vs. 18%; p=0.001), multifocal disease (65% vs. 33%; p=0.01), pN+ (71% vs. 22%; p<0.001), positive surgical margins (24% vs. 4%; p=0.02), and they less commonly demonstrated pure urothelial carcinoma at TURBT (18% vs. 66%; p<0.001). On multivariate analysis, significant predictors of gynecological organ invasion were pN-positive disease (odds ratio [OR] 6.48; 95% confidence interval [CI] 1.64–25.51; p=0.008), trigonal tumour location (OR 5.72; 95% CI 1.39–23.61; p=0.02), and presence of variant histology (OR 18.52; 95% CI 3.32–103.4; p=0.001).Conclusions: Patients with trigonal tumours, variant histology, and nodal involvement are more likely to have gynecological organ invasion at RAAE. This information may help improve counselling of patients and better identify candidates for gynecological organsparing cystectomy.

Reproductive organ involvement in female patients undergoing radical cystectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 274-274
Author(s):  
Hooman Djaladat ◽  
Eila C. Skinner ◽  
Gus Miranda ◽  
Jie Cai ◽  
Siamak Daneshmand
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Strong Predictor ◽  
Clinical Stage ◽  
Reproductive Organs ◽  
Reproductive Organ ◽  
Organ Involvement ◽  
Palpable Mass ◽  
Clinical Criteria ◽  
Female Patients

274 Background: Anterior pelvic exenteration is traditionally the treatment of choice for women with invasive bladder carcinoma. Female reproductive organ involvement is reported to be low, but there is not enough evidence to abandon this part during radical surgery. We evaluated the pathological involvement of reproductive organs (RO) in female patients undergoing radical cystectomy for invasive bladder urothelial carcinoma. Methods: 2,098 patients with bladder cancer underwent cystectomy between 1971 and 2008 at USC, of whom 458 were female. 411 (90%) had urothelial and 47 had non-urothelial bladder cancer. The cohort of female cystectomy patients with pathologic RO involvement is reviewed and their RFS and OS are discussed. Results: In the TCC group, 20 patients (4.8%) had RO involvement by urothelial cancer (UC-RO); 10 (2.5%) had vaginal, 2 (0.5%) cervical and one (0.25%) only uterus involvement with the rest (7) having a combination. In non-UC group, only two (4%) had RO involvement. In the UC-RO cohort, median age was 71 yo (38-89). Only one patient (5%) underwent orthotopic diversion. 19 cases (95%) were high grade TCC. Clinical stage T4a was diagnosed in 25% of cases preoperatively. Associated CIS, multifocality, LVI and histologic type of cancer had no significant correlation with RO involvement. Patients with a palpable mass or hydronephrosis were 5 times more likely to have RO involvement (P<0.001). RO involvement was associated with higher chance of positive lymph nodes (60%) (P=0.001). Three (15%) and seven (35%) patients underwent neo-adjuvant and adjuvant chemotherapy respectively. Urethral pathology was positive in 1 patient. 5 (25%) developed local recurrence and 9 (45%) developed distant metastasis at a median follow up of 12.2 yrs (0.1 to 35.5 yrs). Two-year RFS and five-year OS in UC-RO group were both 10%. Conclusions: The risk of RO involvement in female patients undergoing cystectomy for bladder cancer is about 5%, with the vagina being the most commonly involved organ. A palpable mass and/or hydronephrosis are a strong predictor of RO involvement, although other clinical criteria are not predictive.

scholarly journals Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

2020 ◽  
Vol 9 (2) ◽  
pp. 577 ◽  
Author(s):  
Gabriele Tuderti ◽  
Riccardo Mastroianni ◽  
Simone Flammia ◽  
Mariaconsiglia Ferriero ◽  
Costantino Leonardo ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Functional Outcomes ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Low Grade ◽  
Robot Assisted ◽  
Ileal Neobladder ◽  
Tertiary Referral Center ◽  
Female Patients ◽  
One Year

Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single tertiary referral center. Inclusion criteria were a cT ≤ 2 N0 M0 bladder tumor at baseline imaging (CT or MRI) and an absence of tumors in the bladder neck, trigone and urethra at TURB. Baseline, perioperative, and outcomes at one year were reported. The median operative time was 255 min and the median hospital stay was seven days. Low-grade Clavien complications occurred in four patients (36.3%), while high-grade complications were not observed in any. Seven patients (63.7%) had an organ-confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any of the cases. At a median follow-up of 28 months (IQR 14–51), no patients developed new onset of chronic kidney disease stage 3b. After one year, daytime and nighttime continence rates were 90.9% and 86.4% respectively. Quality of life as well as physical and emotional functioning improved significantly over time (all p ≤ 0.04), while urinary symptoms and sexual function worsened at three months with a significant recovery taking place at one year (all p ≤ 0.04). Overall, 8 out of 11 patients (72.7%) were sexually active at the 12-month evaluation. In select female patients, SS-RARC-iN is an oncologically sound procedure associated with favorable perioperative and functional outcomes.

Reproductive Organ Involvement in Female Patients Undergoing Radical Cystectomy for Urothelial Bladder Cancer

2012 ◽  
Vol 188 (6) ◽  
pp. 2134-2138 ◽  
Author(s):  
Hooman Djaladat ◽  
H. Maxim Bruins ◽  
Gus Miranda ◽  
Jie Cai ◽  
Eila C. Skinner ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Reproductive Organ ◽  
Organ Involvement ◽  
Urothelial Bladder Cancer ◽  
Female Patients ◽  
Urothelial Bladder

scholarly journals Gynecologic organ involvement and incidental gynecologic organ neoplasms in female patients with urothelial carcinoma of the bladder undergoing anterior pelvic exenteration in Rajavithi Hospital

2021 ◽  
Vol 42 (2) ◽  
pp. 97-102
Author(s):  
Keerati i Wattanayingcharoencha ◽  
◽  
Chawawat Gosrisirikul ◽  
Keyword(s):  
Urothelial Carcinoma ◽  
Pelvic Exenteration ◽  
Transitional Cell ◽  
Organ Involvement ◽  
Female Patients ◽  
Increased Risk ◽  
Gynecologic Tumor ◽  
Gynecologic Tumors ◽  
Carcinoma Of The Bladder ◽  
Organ Invasion

Objective: To evaluate the pathological data of the bladder and gynecologic organs obtained from anterior pelvic exenteration and review the incidence of gynecologic organ involvement and primary gynecologic tumor. Materials and Methods: The clinicopathological data of 70 patients who were diagnosed with bladder transitional cell carcinoma and underwent anterior pelvic exenteration in Rajavithi Hospital between January 2008 and October 2020 were analyzed to examine and determine any correlations. Results: Thirteen (18.5%) patients had gynecologic organ involvement. This consisted of 4 cases (5.7%) involving the uterus, 7 (10%) involving the vagina, 2 (2.8%) involving the ovaries, and 10 (14.2%) involving the cervix. Female patients with gynecologic organ invasion were more likely to have a high pathological T stage (p < 0.001), and have pre-operative hydronephrosis (p = 0.002). From multivariate logistic regression, pre-operative hydronephrosis was associated with increased risk of gynecologic organ invasion (odds ratio 9.57; 95% confidence interval, 1.86 - 49.18; p = 0.007). There were 23 (32%) female patients incidentally diagnosed with benign gynecologic tumors, specifically 16 (22%) cases of myoma uteri, 7 (10%) of adenomyosis and 4 (2.8%) with ovarian cysts. No patient was diagnosed as having primary gynecologic malignancy. Conclusions: The incidence of gynecologic organ involvement in female patients who had undergone anterior pelvic exenteration for urothelial carcinoma of the bladder was 18.5%. Pre-operative hydronephrosis was a risk factor associated with increased risk of gynecologic organ involvement. Information from this study may allow better identification of candidates for gynecologic organ sparing surgery.

The influence of variant histology on survival outcomes of radical cystectomy for bladder cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 278-278
Author(s):  
Adrian Stuart Fairey ◽  
Eila C. Skinner ◽  
Anne Schuckman ◽  
Gary Leiskovsky ◽  
Jie Cai ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Survival Data ◽  
Multivariable Analysis ◽  
High Risk Group ◽  
Kaplan Meier ◽  
Variant Histology ◽  
Primary Bladder ◽  
The Impact

278 Background: The role of variant histology bladder cancer as an independent prognostic factor for survival after radical cystectomy is poorly defined. Our aim was to examine the impact of variant histology on survival. Methods: A retrospective analysis of prospectively collected data from the University of Southern California Bladder Cancer Database was performed. Between 1971 and 2008, 2098 patients underwent radical cystectomy and extended pelvic lymph node dissection for primary bladder cancer. All surgical specimens underwent centralized pathologic review by dedicated genitourinary pathologists. Histologic type was categorized according to the WHO/ISUP 1998 classification as urothelial carcinoma (UC; n=1595), UC + variant (n=380), or non-urothelial carcinoma (Non-UC; n=123). The outcomes were overall survival (OS) and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression models were used to analyze survival data. Results: The median follow-up duration was 12.8 years (range, 0 to 36.6 years). The predicted 5-year OS (61%, 53%, and 47%, Log rank p=0.005) and RFS (68%, 59%, and 58%, Log rank p=0.001) rates differed between patients with UC, UC + variant, and Non-UC histology. Multivariable analysis showed that Non-UC (but not UC + variant) histology was independently associated with OS (Non-UC versus UC: HR 1.26, 95% CI 1.01 to 1.57, p=0.040; UC + variant versus UC: HR 0.97, 95% CI 0.85 to 1.12, p=0.697) but not RFS (Non-UC versus UC: HR 1.14, 95% CI 0.83 to 1.56, p=0.411; UC + variant versus UC: HR 1.06, 95% CI 0.88 to 1.28, p=0.551). Conclusions: Non-UC histology was independently associated with poorer OS after radical cystectomy for bladder cancer. Clinical trials are needed to determine whether this high risk group will benefit from multimodal therapy.

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