Richard E Hautmann1, Christian Bolenz2, Björn Volkmer3. 1. Department of Urology, University of Ulm, Ulm, Germany, richard.hautmann@uni-ulm.de. 2. Department of Urology, University of Ulm, Ulm, Germany. 3. Department of Urology, Klinikum Kassel, Kassel, Germany.
Abstract
PURPOSE: To investigate prevalence and variables associated with early oncologic mortality (EOM; within ≥30 to ≤90 days) of open radical cystectomy (RC) for bladder cancer. The unexpected rapidity of tumour recurrence and the huge metastatic burden of these patients drew us to analyse this cohort. METHODS: We reviewed our RC database. All 1,487 patients were treated with curative intent between January 1986 and December 2008. Imaging for staging was done by CT (chest) and CT or MRI (abdomen). Clinical and histopathological variables were recorded until death to determine whether disease- or treatment-related factors were associated with mortality. RESULTS: There were 93 deaths within 90 days of surgery. Twenty-four patients died from early progression to high volume disseminated metastatic disease. Group 1: unresectable tumours, which were never free of disease. Group 2: resectable tumours, considered tumour-free after RC. Group 1 is characterized by local tumour spread and a low distant failure rate. Group 2 has a low local and a high distant failure rate. CONCLUSIONS: Disease related (advanced tumour stage, positive soft tissue surgical margins (+STSM), non urothelial histology, unresectable tumours, atypical occult metastasis), rather than technical factors, had the leading role in EOM. Understaging was universal.
PURPOSE: To investigate prevalence and variables associated with early oncologic mortality (EOM; within ≥30 to ≤90 days) of open radical cystectomy (RC) for bladder cancer. The unexpected rapidity of tumour recurrence and the huge metastatic burden of these patients drew us to analyse this cohort. METHODS: We reviewed our RC database. All 1,487 patients were treated with curative intent between January 1986 and December 2008. Imaging for staging was done by CT (chest) and CT or MRI (abdomen). Clinical and histopathological variables were recorded until death to determine whether disease- or treatment-related factors were associated with mortality. RESULTS: There were 93 deaths within 90 days of surgery. Twenty-four patients died from early progression to high volume disseminated metastatic disease. Group 1: unresectable tumours, which were never free of disease. Group 2: resectable tumours, considered tumour-free after RC. Group 1 is characterized by local tumour spread and a low distant failure rate. Group 2 has a low local and a high distant failure rate. CONCLUSIONS: Disease related (advanced tumour stage, positive soft tissue surgical margins (+STSM), non urothelial histology, unresectable tumours, atypical occult metastasis), rather than technical factors, had the leading role in EOM. Understaging was universal.
Authors: Francesco Claps; Maaike W van de Kamp; Roman Mayr; Peter J Bostrom; Joost L Boormans; Markus Eckstein; Laura S Mertens; Egbert R Boevé; Yann Neuzillet; Maximilian Burger; Damien Pouessel; Carlo Trombetta; Bernd Wullich; Theo H van der Kwast; Arndt Hartmann; Yves Allory; Yair Lotan; Shahrokh F Shariat; Tahlita C M Zuiverloon; M Carmen Mir; Bas W G van Rhijn Journal: World J Urol Date: 2021-07-01 Impact factor: 4.226