Search

Development of late uro-intestinal malignancy after bowel incorporation into the urinary tract is a constant long-term hazard, even in the absence of fecal material. We report 6 such cases.A total of 350 patients treated with an ileal conduit, 260 with ileal replacement of the ureter and 55 with ileocystoplasty were evaluated and followed for a minimum of 4 years. The methods of evaluation included urine analysis for microscopic hematuria, urine culture, serum creatinine and abdominal ultrasonography. These evaluations were performed every 2 months after cystectomy for bladder cancer and every 6 months in other cases. Annual urinary cytology and excretory urography were done. Computerized tomography and/or magnetic resonance imaging was performed annually after radical cystectomy or if there was evidence of hematuria, ureteral obstruction or a filling defect in the bladder, pouch or conduit on excretory urography. Endoscopic evaluation was done in some cases. If malignancy was diagnosed chest x-ray and bone scintigraphy were performed.A total of 645 patients were evaluable. Of these patients late cancer developed at the uro-intestinal anastomotic site in 6 (0.9%), including 1 of 348 (0.3%) who underwent ileal conduit, 3 of 54 (5.5%) ileocystoplasty and 2 of 258 (0.8%) ileal replacement of ureter. The latent period "from the time of original surgery till the development of cancer" ranged from 4 to 32 years (mean plus or minus standard deviation 20.2 +/- 10.9). The pathological type of cancer was adenocarcinoma in 3 patients, transitional cell carcinoma 2 and squamous cell carcinoma 1.Late uro-intestinal malignancy in patients who underwent ileal incorporation in the urinary tract is a low but still distinct risk. Ileocystoplasty is more vulnerable to late uro-enteric cancer than ileal conduit and ileal replacement of ureter. Late malignancy can develop earlier than 10 years postoperatively. Therefore, annual surveillance by routine urine cytology postoperatively is advocated, particularly with enterocystoplasty.

INTRODUCTION AND OBJECTIVES: To identify the prognostic role of lymph node density (LN-d) in a single series of patients undergone RC and to validate findings on an external series. METHODS: Between May 1998 and September 2009 data of 1084 Radical Cystectomies performed at two Institutes were collected in a prospectively-maintained database. After applying selection criteria (neither neoadjuvant nor adjuvant treatments, not salvage cystectomies) 979 out of 1084 patients (695 pN0 and 284 pN ) with non-metastatic bladder carcinoma were selected. The external validation of findings was performed on a single-centre series of 775 patients (590 pN0 and 185 pN ) with the same selection criteria. All patients underwent RC and pelvic lymphnode dissection (PLND). Once lymph node density (LN-d) and lymphnode count (LN-c) cut-off values were identified by maximally selected Log-rank analysis, the prognostic role of several variables on diseasefree survival (DFS) was assessed with univariable and multivariable Cox regression analyses. RESULTS: Statistically significant variables at univariable analysis were histological subtypes (p 0.001) [squamous cell carcinoma (SCC), urothelial carcinoma (UC), urothelial carcinoma with squamous differentiantion (US), adenocarcinoma (AC)], pT (p 0.001), pN (p 0.001), LN-d (p 0.001), PLND extent (p 0.001). At stepwise Cox regression analysis on the internal series of 979 patients pT (p 0.001), LN-d (p 0.001), extent of PLND (p 0.001) and histological subtypes (p 0.001) were independent predictors of DFS (Table 1). On the external cohort of 775 patients pT (p 0.001), LN-d (p 0.001) and histological subtypes (p 0.035) proved to have independent role on DFS (Table 1). CONCLUSIONS: LN-d thresholds identified in the internal cohort were independent predictor of DFS in the external validation cohort. LN-d, pT stage and histological subtypes were the only independent prognostic factors in both series.