Pelvic recurrence following radical cystectomy and orthotopic neobladder substitution for invasive bladder cancer

ABSTRACT

To determine the incidence, characteristics and factors influencing local pelvic recurrence following radical cystectomy and orthotopic neobladder substitution for invasive bladder cancer. Seventy two radical cystectomies and orthotopic neobladder substitution were performed on 70 men and 2 women. Sixty nine patients had transitional cell carcinoma [TCC], 2 patients had squamous cell carcinoma [SCC] and one had rhabdomyosacrcoma. Seven patients with TCC received adjuvant chemotherapy; 6 for micro-nodal disease and one patient had open cystotomy. Median follow up was 36 months. Eight of the 72 patients [11%] developed pelvic recurrence, 6 patients with TCC, one patient with SCC and another with rhabdomyosarcoma. All recurrences developed within 12 months of cystectomy. None of the recurrences involved the uretero-ileal anastomosis. Of the 6 patients with TCC, 4 patients had P3bN+ GIII TCC with vascular invasion while 2 patients had P3aN+ GIII TCC tumors. In one patient with P3b NO GIII TCC the recurrence invaded the neobladder. Three of the 6 patients with TCC had received adjuvant chemotherapy, 2 for positive nodes and one for open cystotomy. Five patients with TCC received a combination of external beam radiation and chetherapy. Partial response was achieved and 3 died of their disease. The patient with SCC was treated with radiation and the patient with recurrent rhabdomyosarcoma, that also invaded the neobladder, had total pelvic extenteration. Both died of their disease. Neobladder tolerated adjuvant chemotherapy and radiation well. Pelvic recurrence following orthotopic neobladder substitution is comparable to other forms of urinary diversion. Factors influencing recurrence are high stage, high grade disease, positive nodes, bladder violation and vascular invasion. Local recurrence can invade the neobladder. Radiation and chemotherapy result in partial response with poor prognosis