Bladder sparing surgery in high-grade bladder cancer

Bladder sparing surgery in high-grade bladder cancer

Summary. The gold standard for managing muscle-invasive bladder cancer is radical cystectomy (RCE). The RCE is a treatment, which carries high burden of perioperative morbidity and mortality. As biomolecular markers make muscle-invasive high-grade bladder cancer (HGBC) an entity different f...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Datum:2023
Hauptverfasser: Yakovlev, P.G., Klyushin, D.A., Vereshchako, R.I.
Format: Artikel
Sprache:English
Veröffentlicht: PH Akademperiodyka 2023
Schlagworte:
adjuvant treatment
bladder sparing surgery
high-grade bladder cancer
survival
Online Zugang:https://exp-oncology.com.ua/index.php/Exp/article/view/2019-2-10
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Назва журналу:Experimental Oncology

Institution

Experimental Oncology
id oai:ojs2.ex.aqua-time.com.ua:article-251
record_format ojs
institution Experimental Oncology
baseUrl_str
datestamp_date 2023-10-11T16:41:24Z
collection OJS
language English
topic adjuvant treatment
bladder sparing surgery
high-grade bladder cancer
survival
spellingShingle adjuvant treatment
bladder sparing surgery
high-grade bladder cancer
survival
Yakovlev, P.G.
Klyushin, D.A.
Vereshchako, R.I.
Bladder sparing surgery in high-grade bladder cancer
topic_facet adjuvant treatment
bladder sparing surgery
high-grade bladder cancer
survival
adjuvant treatment
bladder sparing surgery
high-grade bladder cancer
survival
format Article
author Yakovlev, P.G.
Klyushin, D.A.
Vereshchako, R.I.
author_facet Yakovlev, P.G.
Klyushin, D.A.
Vereshchako, R.I.
author_sort Yakovlev, P.G.
title Bladder sparing surgery in high-grade bladder cancer
title_short Bladder sparing surgery in high-grade bladder cancer
title_full Bladder sparing surgery in high-grade bladder cancer
title_fullStr Bladder sparing surgery in high-grade bladder cancer
title_full_unstemmed Bladder sparing surgery in high-grade bladder cancer
title_sort bladder sparing surgery in high-grade bladder cancer
title_alt Bladder sparing surgery in high-grade bladder cancer
description Summary. The gold standard for managing muscle-invasive bladder cancer is radical cystectomy (RCE). The RCE is a treatment, which carries high burden of perioperative morbidity and mortality. As biomolecular markers make muscle-invasive high-grade bladder cancer (HGBC) an entity different from non-invasive papillary disease, we tested a hypothesis that alternative bladder preserving surgery (BPS) approaches, such as partial cystectomy and transurethral resection of the bladder would not compromise the oncological results of treating HGBC in selected patients. Aim: To study the cancer specific survival of HGBC patients depending on the mode of surgical treatment — RCE, partial en-block cystectomy, and transurethral resection of the bladder in the practice of the Departments of Urology and Oncology of Bogomolets National Medical University, and to assess the prevalence of bladder sparing surgical management of HGBC in local practice as a part of trimodal treatment approach to bladder preservation. Materials and Methods: Retrospectively we studied the medical records of 3597 urothelial bladder cancer patients, of whom 346 (10%) had high-grade disease and who underwent surgical treatment in 2004–2017. All patients were studied with contact computed tomography of the chest, abdomen, pelvis, and biopsy of the tumor. Based on the results of the diagnostic workup the choice of surgical treatment between RCE, partial cystectomy and transurethral resection was made considering the size of the tumor, location of the tumor in the bladder in relation to the bladder neck, and technical and oncological feasibility of performing the bladder sparing surgery. Kaplan — Meier survival curves were built to compare the results of survival per cancer stage and type of surgical treatment. Survival data of the patients were collected from the cancer registry maintained at the Kyiv Municipal Clinical Oncological Center. Results of data analysis were controlled for confounding parameters, such as adjuvant treatment: perioperative radiotherapy, and chemotherapy. Results: Median follow-up was 93 months (1–226 months). Males were 276 (80%). Average age at diagnosis was 62 ± 4.5 years. By the time of the study 61% of patients have died due to the progression of the disease. All patients with stage I disease (7% or 24 patients) were managed with bladder-sparing surgery. In muscle-invasive disease (309 patients), the RCE was performed in 109 (35.3%) patients, partial cystectomy was performed in 79 (25.6%) patients, and transurethral resection — in 121 (39.1%) patients. The overall 5-year survival of HGBC patients after radical surgical treatment (RCE/BPS) for stage I patients was 0%/83%, for stage II — 43%/58%, for stage III — 37%/42%, and for stage IV — 10%/40%. A total of 44 patients (12.7% of all treated, and 19.6% of treated with bladder sparing) received postoperative radiotherapy after bladder-sparing surgery. A total of 14 patients (4% of all treated) received postoperative chemotherapy. Conclusion: Bladder sparing surgery (partial en-block cystectomy, and transurethral resection of the bladder) in selected patients is not inferior to RCE in terms of cancer-specific survival when treating patients with HGBC of all stages. The bladder sparing surgery was performed in 64.7% of patients with high grade bladder cancer. Utilization of adjuvant treatment is low, 12.7% for postoperative radiotherapy, and 4% for perioperative chemotherapy
publisher PH Akademperiodyka
publishDate 2023
url https://exp-oncology.com.ua/index.php/Exp/article/view/2019-2-10
work_keys_str_mv AT yakovlevpg bladdersparingsurgeryinhighgradebladdercancer
AT klyushinda bladdersparingsurgeryinhighgradebladdercancer
AT vereshchakori bladdersparingsurgeryinhighgradebladdercancer
first_indexed 2025-07-17T12:17:03Z
last_indexed 2025-07-17T12:17:03Z
_version_ 1850411293732765696
spelling oai:ojs2.ex.aqua-time.com.ua:article-2512023-10-11T16:41:24Z Bladder sparing surgery in high-grade bladder cancer Bladder sparing surgery in high-grade bladder cancer Yakovlev, P.G. Klyushin, D.A. Vereshchako, R.I. adjuvant treatment, bladder sparing surgery, high-grade bladder cancer, survival adjuvant treatment, bladder sparing surgery, high-grade bladder cancer, survival Summary. The gold standard for managing muscle-invasive bladder cancer is radical cystectomy (RCE). The RCE is a treatment, which carries high burden of perioperative morbidity and mortality. As biomolecular markers make muscle-invasive high-grade bladder cancer (HGBC) an entity different from non-invasive papillary disease, we tested a hypothesis that alternative bladder preserving surgery (BPS) approaches, such as partial cystectomy and transurethral resection of the bladder would not compromise the oncological results of treating HGBC in selected patients. Aim: To study the cancer specific survival of HGBC patients depending on the mode of surgical treatment — RCE, partial en-block cystectomy, and transurethral resection of the bladder in the practice of the Departments of Urology and Oncology of Bogomolets National Medical University, and to assess the prevalence of bladder sparing surgical management of HGBC in local practice as a part of trimodal treatment approach to bladder preservation. Materials and Methods: Retrospectively we studied the medical records of 3597 urothelial bladder cancer patients, of whom 346 (10%) had high-grade disease and who underwent surgical treatment in 2004–2017. All patients were studied with contact computed tomography of the chest, abdomen, pelvis, and biopsy of the tumor. Based on the results of the diagnostic workup the choice of surgical treatment between RCE, partial cystectomy and transurethral resection was made considering the size of the tumor, location of the tumor in the bladder in relation to the bladder neck, and technical and oncological feasibility of performing the bladder sparing surgery. Kaplan — Meier survival curves were built to compare the results of survival per cancer stage and type of surgical treatment. Survival data of the patients were collected from the cancer registry maintained at the Kyiv Municipal Clinical Oncological Center. Results of data analysis were controlled for confounding parameters, such as adjuvant treatment: perioperative radiotherapy, and chemotherapy. Results: Median follow-up was 93 months (1–226 months). Males were 276 (80%). Average age at diagnosis was 62 ± 4.5 years. By the time of the study 61% of patients have died due to the progression of the disease. All patients with stage I disease (7% or 24 patients) were managed with bladder-sparing surgery. In muscle-invasive disease (309 patients), the RCE was performed in 109 (35.3%) patients, partial cystectomy was performed in 79 (25.6%) patients, and transurethral resection — in 121 (39.1%) patients. The overall 5-year survival of HGBC patients after radical surgical treatment (RCE/BPS) for stage I patients was 0%/83%, for stage II — 43%/58%, for stage III — 37%/42%, and for stage IV — 10%/40%. A total of 44 patients (12.7% of all treated, and 19.6% of treated with bladder sparing) received postoperative radiotherapy after bladder-sparing surgery. A total of 14 patients (4% of all treated) received postoperative chemotherapy. Conclusion: Bladder sparing surgery (partial en-block cystectomy, and transurethral resection of the bladder) in selected patients is not inferior to RCE in terms of cancer-specific survival when treating patients with HGBC of all stages. The bladder sparing surgery was performed in 64.7% of patients with high grade bladder cancer. Utilization of adjuvant treatment is low, 12.7% for postoperative radiotherapy, and 4% for perioperative chemotherapy Summary. The gold standard for managing muscle-invasive bladder cancer is radical cystectomy (RCE). The RCE is a treatment, which carries high burden of perioperative morbidity and mortality. As biomolecular markers make muscle-invasive high-grade bladder cancer (HGBC) an entity different from non-invasive papillary disease, we tested a hypothesis that alternative bladder preserving surgery (BPS) approaches, such as partial cystectomy and transurethral resection of the bladder would not compromise the oncological results of treating HGBC in selected patients. Aim: To study the cancer specific survival of HGBC patients depending on the mode of surgical treatment — RCE, partial en-block cystectomy, and transurethral resection of the bladder in the practice of the Departments of Urology and Oncology of Bogomolets National Medical University, and to assess the prevalence of bladder sparing surgical management of HGBC in local practice as a part of trimodal treatment approach to bladder preservation. Materials and Methods: Retrospectively we studied the medical records of 3597 urothelial bladder cancer patients, of whom 346 (10%) had high-grade disease and who underwent surgical treatment in 2004–2017. All patients were studied with contact computed tomography of the chest, abdomen, pelvis, and biopsy of the tumor. Based on the results of the diagnostic workup the choice of surgical treatment between RCE, partial cystectomy and transurethral resection was made considering the size of the tumor, location of the tumor in the bladder in relation to the bladder neck, and technical and oncological feasibility of performing the bladder sparing surgery. Kaplan — Meier survival curves were built to compare the results of survival per cancer stage and type of surgical treatment. Survival data of the patients were collected from the cancer registry maintained at the Kyiv Municipal Clinical Oncological Center. Results of data analysis were controlled for confounding parameters, such as adjuvant treatment: perioperative radiotherapy, and chemotherapy. Results: Median follow-up was 93 months (1–226 months). Males were 276 (80%). Average age at diagnosis was 62 ± 4.5 years. By the time of the study 61% of patients have died due to the progression of the disease. All patients with stage I disease (7% or 24 patients) were managed with bladder-sparing surgery. In muscle-invasive disease (309 patients), the RCE was performed in 109 (35.3%) patients, partial cystectomy was performed in 79 (25.6%) patients, and transurethral resection — in 121 (39.1%) patients. The overall 5-year survival of HGBC patients after radical surgical treatment (RCE/BPS) for stage I patients was 0%/83%, for stage II — 43%/58%, for stage III — 37%/42%, and for stage IV — 10%/40%. A total of 44 patients (12.7% of all treated, and 19.6% of treated with bladder sparing) received postoperative radiotherapy after bladder-sparing surgery. A total of 14 patients (4% of all treated) received postoperative chemotherapy. Conclusion: Bladder sparing surgery (partial en-block cystectomy, and transurethral resection of the bladder) in selected patients is not inferior to RCE in terms of cancer-specific survival when treating patients with HGBC of all stages. The bladder sparing surgery was performed in 64.7% of patients with high grade bladder cancer. Utilization of adjuvant treatment is low, 12.7% for postoperative radiotherapy, and 4% for perioperative chemotherapy PH Akademperiodyka 2023-06-05 Article Article application/pdf https://exp-oncology.com.ua/index.php/Exp/article/view/2019-2-10 10.32471/exp-oncology.2312-8852.vol-41-no-2.13207 Experimental Oncology; Vol. 41 No. 2 (2019): Experimental Oncology; 160-165 Експериментальна онкологія; Том 41 № 2 (2019): Експериментальна онкологія; 160-165 2312-8852 1812-9269 10.32471/exp-oncology.2312-8852.vol-41-no-2 en https://exp-oncology.com.ua/index.php/Exp/article/view/2019-2-10/2019-2-10 Copyright (c) 2023 Experimental Oncology https://creativecommons.org/licenses/by-nc/4.0/

Ähnliche Einträge