Significance of intraoperative ureteral evaluation at radical cystectomy for urothelial cancer.
Academic Article
Overview
abstract
BACKGROUND: Patients undergoing radical cystectomy (RC) for urothelial cancer are at increased risk for upper tract recurrence and anastomotic recurrence. In an attempt to reduce this recurrence risk, urologists employ intraoperative frozen sections to achieve an uninvolved ureteral margin. The utility of this surgical approach was examined. METHODS: A retrospective review identified 1330 bladder cancer patients from 1990 to 2004 with pathologic evaluation of their ureters. Using pathologic findings on permanent section as the reference standard, the accuracy of ureteral frozen sections was examined. Ureteral involvement and margin status were examined as risk factors for upper tract and anastomotic recurrence and overall survival. RESULTS: Of 2579 ureteral margins evaluated in 1330 patients, ureteral involvement was noted in 9% of ureters (13% of patients). The sensitivity and specificity of frozen section analyses were approximately 75% and 99%, respectively. The 5-year probability of anastomotic and upper tract recurrences was low: 2% and 13%, respectively. Evidence of involvement of the ureter or at the ureteral anastomotic margin was associated with higher likelihood of upper tract recurrence but not anastomotic recurrence or overall survival. Furthermore, sequential resection of ureters to reach a negative anastomotic ureteral margin did not eliminate the risk of anastomotic or upper tract recurrence. CONCLUSIONS: Patients with involved ureters and/or ureteral anastomotic margins have a higher risk of upper tract recurrence. However, the overall risk of recurrence is low and is not clearly associated with overall survival. The data do not support routine intraoperative frozen sections to assess ureteral involvement.
