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13-03-2013 | Internal medicine | Article

Salvage surgery prolongs survival after partial cystectomy failure


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medwireNews: Salvage radical cystectomy can extend the survival of patients who have recurrent urothelial bladder following a partial cystectomy, research shows.

However, the prognosis following salvage radical cystectomy is highly dependent on the pathologic tumor stage and nodal status.

In a multivariate analysis, a pathologic tumor stage of pT3a or above and the presence of lymph node metastases were both associated with a significantly increased risk for recurrence following salvage radical cystectomy.

"Most patients with local recurrence following partial cystectomy can be salvaged by radical cystectomy," state Harman Bruins (University of Southern California, Los Angeles, USA) and colleagues. "In patients with recurrent disease confined to the bladder, aggressive surgical management provides a good chance of salvage."

As reported in BJU International, the researchers studied 2290 patients undergoing radical cystectomy for urothelial carcinoma of the bladder. Of these patients, 72 (3.1%) individuals underwent salvage radical cystectomy following the initial bladder-sparing cystectomy.

The median time from partial cystectomy to salvage surgery was 1.6 years and the median age at the time of the second procedure was 64 years. The 5- and 10-year rate of overall survival was 41% and 35%, respectively, while the corresponding rates of recurrence-free survival were 56% and 51%, respectively.

After salvage radical cystectomy, 44 patients had cancer confined to the bladder, 14 patients had extravesical disease, and 14 patients had lymph node-positive disease.

When stratified by pathologic subgroups, recurrence-free and overall survival was significantly higher in patients with organ-confined disease compared with those who additionally had extravesical and lymph node-positive disease, the latter group's 5-year rate of recurrence-free survival being just 22%.

In a multivariate-adjusted model, the presence of extravesical disease was associated with nearly a sevenfold increased risk for recurrence after salvage radical cystectomy. Similarly, lymph node-positive disease was associated with a near ninefold increased risk for recurrence following salvage surgery.

One explanation for the poor prognosis in extravesical and lymph node-positive cases in the salvage radical cystectomy group "may be a more aggressive biological behavior of the recurred tumor," state Bruins et al.

The research team regards recurrent urothelial cancer in the preserved bladder after partial cystectomy as an "important concern," when it is currently estimated that 25% to 30% of these patients ultimately require salvage cystectomy.

Furthermore, given that salvage radical cystectomy will not cure all patients with recurrent disease, it is important to identify which factors influence long-term survival, conclude the researchers.

By medwireNews Reporters

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