Ruolo clinico predittivo e decisionale dello stato dei margini chirurgici dopo cistectomia radicale per neoplasia vescicale.

Radical cystectomy completed with an extended pelvic lymph node dissection represents the most adequate curative treatment for muscle-invasive bladder cancer . After surgery, the tumor should be considered as completely removed only if the pathologist finds negative surgical margins. However, although the presence of positive surgical margins (PSM) intuitively appears as a factor conditioning a poor prognosis, the studies published at data could not definitively confirm this relationship. This fact may be mainly attributed to the lack of statistical independence between the presence of PSM and other pathologic factors such as tumor stage and lymph node status, that are themselves well known predictors of poor prognosis. The incidence of PSM has been estimated to be 3-9%. Although the persistence of tumor at both urethral and ureteral margins has been correlated with an increased risk of local recurrence, only perivesical soft tissue PSM have been associated with a significantly reduced risk of cancer-specific survival. Female gender, locally advanced cancer, presence of vascular invasion and rare/mixed histology have been recognized as consistent risk factors for soft tissue PSM. Although, to date, the predictive role of both number and location of PSM remains totally to be investigated, there is general agreement that patients found with soft tissue PSM at the time of radical cystectomy should be proposed for adjuvant strategies, including radiation and chemotherapy. In this direction, many recent studies suggest to include the status of surgical margins in the pathologic report of any radical cystectomy. [ABSTRACT FROM AUTHOR]