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Seminars in Radiation Oncology Jan 2023Organ preservation for muscle-invasive bladder cancer (MIBC) may use trimodality therapy. This includes transurethral resection followed by radiation therapy.... (Review)
Review
Organ preservation for muscle-invasive bladder cancer (MIBC) may use trimodality therapy. This includes transurethral resection followed by radiation therapy. Radiosensitization has become one of the standard of care approaches for MIBC with high rates of local disease control and overall survival. The goal of organ preservation is to treat MIBC while preserving a well-functioning natural bladder. Debate remains over the best way to optimize radiation therapy in bladder cancer. In MIBC the role of partial cystectomy has been utilized in smaller solitary tumors with adequate local control and good urinary function. As radiation therapy techniques improve and modernize, smaller radiation volumes to a partial bladder may play an increasing role as we utilize imaging techniques coupled with adaptive radiation therapy planning and other techniques such as brachytherapy. In this review, we explore the use of brachytherapy and partial bladder fields of external beam radiation therapy in the treatment of MIBC.
Topics: Humans; Urinary Bladder; Brachytherapy; Combined Modality Therapy; Cystectomy; Urinary Bladder Neoplasms; Neoplasm Invasiveness
PubMed: 36517197
DOI: 10.1016/j.semradonc.2022.10.010 -
The Journal of Urology Sep 2004Partial cystectomy is a bladder sparing procedure that has been used to treat invasive bladder cancer in highly selected patients. This study analyzes the outcomes of...
PURPOSE
Partial cystectomy is a bladder sparing procedure that has been used to treat invasive bladder cancer in highly selected patients. This study analyzes the outcomes of partial cystectomy in a contemporary cohort of patients to identify appropriate selection criteria for the procedure.
MATERIALS AND METHODS
Records were reviewed for 58 patients with a primary bladder tumor who had undergone partial cystectomy at Memorial Sloan-Kettering Cancer Center from 1995 to 2001. Information was collected on tumor size, histology, location, presence of carcinoma in situ (CIS), multifocality, neoadjuvant treatment, clinical stage, pathological stage and disease status.
RESULTS
For the 58 patients analyzed, overall 5-year survival was 69% with a mean followup of 33 months (range 1 to 83). Of the patients 43 (74%) are alive with an intact bladder, 39 (67%) are currently disease-free with an intact bladder and 32 (55%) have been continuously disease-free with an intact bladder. Seven patients experienced a superficial recurrence and were treated successfully while 15 patients experienced an advanced recurrence. On univariate analysis CIS and multifocality were related to superficial recurrence, and lymph node involvement and positive surgical margin were related to advanced recurrence. On multivariate analysis concomitant CIS (odds ratio 7.05, p = 0.004) and lymph node involvement (odds ratio 4.38, p = 0.031) were predictors of advanced recurrence.
CONCLUSIONS
In highly selected patients with invasive bladder cancer, partial cystectomy offers acceptable outcomes. Concomitant CIS and presence of metastases to regional lymph nodes predict advanced recurrence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma in Situ; Carcinoma, Transitional Cell; Cystectomy; Disease-Free Survival; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Patient Selection; Postoperative Complications; Risk Factors; Survival Rate; Urinary Bladder Neoplasms
PubMed: 15310988
DOI: 10.1097/01.ju.0000135530.59860.7d -
BJU International Aug 2007To present our initial experience with laparoscopic partial cystectomy (LPC) in selected patients with various bladder pathologies.
OBJECTIVE
To present our initial experience with laparoscopic partial cystectomy (LPC) in selected patients with various bladder pathologies.
PATIENTS AND METHODS
Between December 2004 and April 2006, four patients had LPC at our centre (mean age 52 years, range 35-70); the transperitoneal approach was used for three and a pre-peritoneal approach for one. The surgical procedures used sequentially included transurethral incision around the lesion, laparoscopic excision of the lesion (partial cystectomy) and intracorporeal suturing. Laparoscopic pelvic lymphadenectomy was also used for the two patients with malignancy.
RESULTS
All operations proceeded smoothly; the bladder pathologies included one bladder endometriosis, one bladder leiomyoma, one urothelial carcinoma within the bladder diverticulum and one urachal adenocarcinoma. The mean (range) operative duration was 197.5 (120-300) min, the estimated blood loss 70 (50-100) mL, the hospital stay 6.75 (5-9) days, and duration of Foley catheterization 7.25 (6-9) days. No open conversion was required and no patient had peri-operative complications. The surgical margins were free of cancer and the dissected lymph nodes were negative in those two patients with bladder malignancy.
CONCLUSIONS
LPC is safe and feasible in selected patients with various bladder pathologies.
Topics: Adult; Aged; Blood Loss, Surgical; Catheterization; Cystectomy; Feasibility Studies; Female; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Urinary Bladder Diseases
PubMed: 17506869
DOI: 10.1111/j.1464-410X.2007.06935.x -
Clinical Genitourinary Cancer Dec 2023Local tumor invasion depth has been associated with lymph node metastasis in urothelial carcinoma, and, for muscle-invasive bladder cancer (MIBC), pelvic lymph node...
INTRODUCTION
Local tumor invasion depth has been associated with lymph node metastasis in urothelial carcinoma, and, for muscle-invasive bladder cancer (MIBC), pelvic lymph node dissection (PLND) is a critical step in curative surgery. Gold standard treatment includes radical cystectomy (RC), but partial cystectomy (PC) is an important bladder-preserving modality reserved for patients with certain favorable prognostic indicators. There is poor evidence concerning the utility of PLND in PC and we seek to further define its role by comparing survival outcomes when PLND was cursory or omitted.
METHODS
A retrospective analysis of 13,652 cT2N0M0 patients who underwent PC or RC between 2004 and 2016 was performed using the National Cancer Database. Patients undergoing PC were stratified by the presence of PLND as well as by node yield >15. The primary outcome was overall survival, analyzed using the Kaplan-Meier Method and multivariable Cox-proportional hazards regression. Multivariable models were adjusted for confounding clinicopathologic variables.
RESULTS
From 2004 to 2016, PLND in PC increased from 44% to 57% with RC remaining over 90%. Compared to RC, PC was approximately twice as likely to be performed at community centers and approached laparoscopically/robotically (P < .001). When stratifying PC PLND yield into 1 to 15 and > 15 compared to PC without PLND, the adjusted hazard ratios for overall mortality were 0.78 and 0.54, respectively (P < .05).
CONCLUSIONS
PC patients had a significantly lower rate of PLND compared to RC and improved survival when performed versus PC alone. Furthermore, increased node yield was associated with a larger reduction of adjusted mortality hazard. For MIBC patients that are appropriately selected for PC, high-yield PLND should be prioritized given the significantly improved survival outcomes.
Topics: Humans; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Cystectomy; Urinary Bladder; Retrospective Studies; Lymph Nodes; Lymph Node Excision; Muscles; Treatment Outcome
PubMed: 37336704
DOI: 10.1016/j.clgc.2023.05.020 -
Urologic Oncology Aug 2023While radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC), partial cystectomy (PC) is an effective alternative in select patients....
PURPOSE
While radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC), partial cystectomy (PC) is an effective alternative in select patients. We sought to examine differences in survival for RC and PC in a hospital-based registry.
MATERIAL AND METHODS
We identified patients diagnosed with cT2-4 bladder cancer who underwent RC or PC from 2003 to 2015 in the National Cancer Database (NCDB). Using inverse probability treatment weighting (IPTW) to control for known confounders, we compared the primary outcome of overall survival (OS) in patients who underwent RC vs. PC. Kaplan-Meier survival analysis, univariable and multivariable Cox proportional hazards modeling were used. We performed a secondary survival analysis for a subcohort of patients with cT2, cN0, tumor size ≤5 cm, and no concurrent carcinoma in situ (CIS), who may be optimal candidates for PC.
RESULTS
A total of 22,534 patients met inclusion criteria, of which 6.9% (1,457) underwent PC. RC had longer median OS than PC (67.8 vs. 54.1 months) and on Cox regression analysis (HR 0.88, 95% CI, 0.80-0.95, P = 0.002). However, in our subcohort, there was no difference in OS between RC and PC (HR 1.02, 95% CI, 0.9-1.2, P = 0.74). PC was associated with increased time from surgery to any systemic therapy or death in the subcohort.
CONCLUSIONS
Among patients with clinically organ-confined MIBC, PC appears to afford similar survival outcomes to RC in a large national data set. The safety and tolerability of PC may warrant consideration in highly selected patients.
Topics: Humans; Cystectomy; Urinary Bladder Neoplasms; Survival Analysis; Kaplan-Meier Estimate; Muscles; Treatment Outcome
PubMed: 37210247
DOI: 10.1016/j.urolonc.2023.04.017 -
International Braz J Urol : Official... 2004The authors present their initial experience with a selected group of patients who underwent laparoscopic partial cystectomy for treating bladder cancer.
PROPOSAL
The authors present their initial experience with a selected group of patients who underwent laparoscopic partial cystectomy for treating bladder cancer.
MATERIALS AND METHODS
In the period from June 1997 to April 2000, 6 patients, aged between 38 and 76 years, having transitional cell carcinoma of the bladder, were identified as candidates to partial cystectomy. The procedure employed consisted in laparoscopic partial cystectomy and lymphadenectomy with exclusive intracorporeal suture technique.
RESULTS
The proposed procedure was completed in all cases. Mean surgical time was 205 minutes and mean blood loss was 200 mL. There were no significant complications during both intra- and post-operative period. Two patients (33%) presented urinary extravasation of less than 50 mL, with spontaneous resolution. Mean hospitalization period was 4 days (2 to 6). The histological analysis of the resected specimens revealed transitional cell carcinoma, stage pT1G3 in case 1, pT2aG2 in cases 2 to 4, pT2bG2 in case 5 and pT3aG3 in case 6. The resection margins, as well as lymph nodes, were free of neoplasia. One patient developed local and metastatic disease, and was treated with salvage chemotherapy. No other case of local or systemic recurrence was observed with a mean follow-up of 30 months.
CONCLUSIONS
Laparoscopic partial cystectomy can be an alternative surgical method for treating selected cases of patients with transitional cell carcinoma of the bladder.
Topics: Adult; Aged; Carcinoma, Transitional Cell; Cystectomy; Female; Humans; Laparoscopy; Male; Middle Aged; Urinary Bladder Neoplasms
PubMed: 15689245
DOI: 10.1590/s1677-55382004000300003 -
PloS One 2018Cystectomy is the removal of all or part of the urinary bladder. It has been observed that there is significant regrowth of the bladder after partial cystectomy and this...
Cystectomy is the removal of all or part of the urinary bladder. It has been observed that there is significant regrowth of the bladder after partial cystectomy and this has been proposed to be through regeneration of the organ. Regrowth of tissue in mammals has been proposed to involve compensatory mechanisms that share many characteristics of true regeneration, like the growth of specialized structures such as blood vessels or nerves. However, the overall structure of the normal organ is not achieved. Here we tested if bladder growth after subtotal cystectomy (STC, removal of 50% of the bladder) was compensatory or regenerative. To do this we subjected adult female mouse bladders to STC and assessed regrowth using several established cellular parameters including histological, gene expression, cytokine accumulation and cell proliferation studies. Bladder function was analyzed using cystometry and the voiding stain on paper (VSOP) technique. We found that STC bladders were able to increase their ability to hold urine with the majority of volume restoration occurring within the first two weeks. Regenerating bladders had thinner walls with less mean muscle thickness, and they showed increased collagen deposition at the incision as well as throughout the bladder wall suggesting that fibrosis was occurring. Cell populations differed in their response to injury with urothelial regeneration complete by day 7, but stromal and detrusor muscle still incomplete after 8wks. Cells incorporated EdU when administered at the time of surgery and tracing of EdU positive cells over time indicated that many newborn cells originate at the incision and move mediolaterally. Basal urothelial cells and bladder mesenchymal stem cells but not smooth muscle cells significantly incorporated EdU after STC. Since anti-inflammatory cytokines play a role in regeneration, we analyzed expressed cytokines and found that no anti-inflammatory cytokines were present in the bladder 1wk after STC. Our findings suggest that bladder regrowth after cystectomy is compensatory and functions to increase the volume that the bladder can hold. This finding sets the stage for understanding how the bladder responds to cystectomy and how this can be improved in patients after suffering bladder injury.
Topics: Animals; Cicatrix; Collagen; Cystectomy; Cytokines; Female; Fibrosis; Gene Expression Regulation; Mice; Recovery of Function; Regeneration; Urinary Bladder
PubMed: 30475828
DOI: 10.1371/journal.pone.0206436 -
Gynecologie, Obstetrique & Fertilite Jun 2016To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. (Comparative Study)
Comparative Study
OBJECTIVES
To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis.
METHODS
A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level.
RESULTS
We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6.
CONCLUSIONS
Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications.
Topics: Adult; Cystectomy; Endometriosis; Female; Humans; Laparoscopy; Postoperative Complications; Recurrence; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Diseases
PubMed: 27032760
DOI: 10.1016/j.gyobfe.2016.02.006 -
Acta Urologica Belgica Jan 1964
Topics: Biometry; Cystectomy; Neoplasms; Surgical Procedures, Operative; Urinary Bladder Neoplasms
PubMed: 14111383
DOI: No ID Found -
Acta Urologica Belgica Jan 1964
Topics: Cystectomy; Surgical Procedures, Operative; Urinary Bladder Neoplasms
PubMed: 14111381
DOI: No ID Found