Marco Moschini1, Andrea Gallina2, Massimo Freschi3, Stefano Luzzago2, Nicola Fossati2, Giorgio Gandaglia2, Paolo Dell'oglio2, Rocco Damiano4, Vincenzo Serretta5, Andrea Salonia2, Francesco Montorsi2, Alberto Briganti2, Renzo Colombo2. 1. Department of Urology, Urological Research Institute, Vita-Salute, University, San Raffaele Scientific Institute, Milano, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy. Electronic address: marco.moschini87@gmail.com. 2. Department of Urology, Urological Research Institute, Vita-Salute, University, San Raffaele Scientific Institute, Milano, Italy. 3. Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy. 4. Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy. 5. Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy.
Abstract
BACKGROUND: Despite several studies, the adequate management of positive distal ureter margins at the time of radical cystectomy (RC) remains controversial. Particularly, it is not clear whether the achievement of negative distal ureter margins at the intraoperative frozen sections (IFS) affects postoperative cancer-specific mortality (CSM). METHODS: In all, 1,447 consecutive patients treated with RC at a single center between January 1987 and August 2014 were considered. Multivariable (MVA) logistic regression analyses were used to determine predictors of positive IFS. MVA Cox regression analyses were used to test the effect on CSM of intraoperative conversion to negative margins. RESULTS: At IFS, 368 patients (25%) experienced at least 1 positive margin. Of these, a negative conversion of the margin at IFS occurred in 178 (48%) whereas 190 (52%) had a positive final ureteral margin. The mean follow-up was 95 months (median = 102). At MVA, history of carcinoma in situ (odds ratio = 6.40, P<0.001) was predictors of positive margin at IFS. At MVA, ureteral margins that were not converted to negative (hazard ratio = 1.92, P = 0.01) were associated with CSM but only in patients with negative soft tissue margin and without node metastases. CONCLUSIONS: Achieving negative IFS margins may be associated with survival benefit in patients without residual bladder cancer after RC. Patients who recorded a history of carcinoma in situ before RC are at higher risk to incur positive ureteral margin at IFS and should be investigated during RC.
BACKGROUND: Despite several studies, the adequate management of positive distal ureter margins at the time of radical cystectomy (RC) remains controversial. Particularly, it is not clear whether the achievement of negative distal ureter margins at the intraoperative frozen sections (IFS) affects postoperative cancer-specific mortality (CSM). METHODS: In all, 1,447 consecutive patients treated with RC at a single center between January 1987 and August 2014 were considered. Multivariable (MVA) logistic regression analyses were used to determine predictors of positive IFS. MVA Cox regression analyses were used to test the effect on CSM of intraoperative conversion to negative margins. RESULTS: At IFS, 368 patients (25%) experienced at least 1 positive margin. Of these, a negative conversion of the margin at IFS occurred in 178 (48%) whereas 190 (52%) had a positive final ureteral margin. The mean follow-up was 95 months (median = 102). At MVA, history of carcinoma in situ (odds ratio = 6.40, P<0.001) was predictors of positive margin at IFS. At MVA, ureteral margins that were not converted to negative (hazard ratio = 1.92, P = 0.01) were associated with CSM but only in patients with negative soft tissue margin and without node metastases. CONCLUSIONS: Achieving negative IFS margins may be associated with survival benefit in patients without residual bladder cancer after RC. Patients who recorded a history of carcinoma in situ before RC are at higher risk to incur positive ureteral margin at IFS and should be investigated during RC.
Authors: Joanne Tang; Weranja Ranasinghe; Janice Cheng; Sabiena Van Es; Mike Monsour; Richard Cetti; Robert Jensen; Steve Brough Journal: Curr Urol Date: 2019-03-08