1133 RENAL FUNCTION EVALUATION AFTER ORTHOTOPIC ILEAL NEOBLADDER WITH EXTRAMURAL SEROUS-LINED URETERAL REIMPLANTATION: CHRONIC KIDNEY DISEASE EPIDEMIOLOGY COLLABORATION VERSUS MODIFICATION OF DIET IN RENAL DISEASE EQUATIONS

Abstract

Listen

Translate article

INTRODUCTION AND OBJECTIVES: Presence of transitional cell carcinoma in the prostatic stroma is associated with increased risk of urethral recurrence and mortality. Patients with T4a bladder cancer are generally not considered good candidates for orthotopic neobladder (ON) diversion and are typically offered neoadjuvant chemotherapy if known pre-operatively. We evaluated urethral and local recurrence, and oncologic outcomes in male patients with pT4a bladder cancer who underwent heterotopic vs. orthotopic urinary diversion following radical cystectomy. METHODS: 1,964 bladder cancer patients who underwent radical cystectomy at University of Southern California between 1971 and 2008 were analyzed retrospectively. Male patients who had pT4a disease at cystectomy were included. Patients with 30 day perioperative mortality were excluded. Univariate and log rank statistics were used to examine associations between variables and outcome. RESULTS: 156 (7.9%) patients met the inclusion criteria (table 1). Only 45 (28.8%) of these patients were diagnosed with clinical T4a disease prior to cystectomy. Median follow up was 2.7 yrs (range, 0.1–23.6 yrs) during which 118 (75.6%) patients died. There was no difference in 3-yr recurrence free survival between orthotopic and heterotopic diversion (31 7% and 38 7% respectively). This held true even after stratifying by nodal stage (p 0.81) and administration of adjuvant chemotherapy (p 0.66). No significant difference in recurrence course or location was noted between diversion types (log rank p 0.63). There was also no significant difference in overall survival between diversion types univariately (p 0.79), and after multivariate stratification. CONCLUSIONS: Outcomes of patients with pT4a bladder cancer do not differ significantly depending on type of urinary diversion. Orthotopic diversion in pT4a patients was not associated with increased local or urethral recurrence risk. In this subgroup of patients, ON may therefore be a feasible alternative with comparable oncologic outcomes and potentially better quality of life.