1418 THE RISK OF TUMOR-RELATED COMPLICATIONS IN PATIENTS WITH ILEAL-NEOBLADDERS

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (II)1 Apr 20131418 THE RISK OF TUMOR-RELATED COMPLICATIONS IN PATIENTS WITH ILEAL-NEOBLADDERS Bjoern Volkmer, Karen Czeloth, Regina Stredele, and Richard Hautmann Bjoern VolkmerBjoern Volkmer Kassel, Germany More articles by this author , Karen CzelothKaren Czeloth Kassel, Germany More articles by this author , Regina StredeleRegina Stredele Kassel, Germany More articles by this author , and Richard HautmannRichard Hautmann Ulm, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy is a standard therapy for invasive bladder cancer. The choice of urinary diversion is often affected by the surgeons' fear of tumor complications. Since an ileal neobladder is the form of urinary diversion that is located exactly at the former tumor site, it is important to evaluate the real extent of this risk in a neobladder population. METHODS This study is based on the cystectomy series of the University of Ulm 01/86 - 12/08 and of the Kassel General Hospital 01/00 - 12/08. We included all patients with a cystectomy performed for urothelial bladder cancer. The tumor stage was non-organ confined (at least pT3a), or lymph-node positive or metastatic (M1). We excluded those cases with age > 75y and those with macroscopic residual tumor in the true pelvis (R2). We obtained a complete follow-up until 12/08. The mean follow-up was 35 months. RESULTS We included 540 patients (Ulm: 471, Kassel: 69). The 5- and 10-year overall survival was 27.6% and 16.2%, respectively. 284 patients had an ileal neobladder (NBL), 256 other forms of urinary diversion (OTH). The rates of lymph-node metastases and distant metastases were: NBL: 63% and 6%, OTH: 56% and 13%. After 10 years the overall survival was better in the NBL group for pT3b-4b pN0/1 tumors (28.6% vs. 17.6%) and for pN2-3 or M1 tumors (8.0% vs. 3.7%).The rate of local recurrence was 17.3% in the NBL-group, but only 18/49 patients developed tumor-related neobladder complications (6.3% of all neobladder patients in this group): hydronephrosis (n=8), subneovesical obstruction (n=4), hematuria (n=4), neovesico-intestinal fistula (n=5). In all cases the storage function of the neobladder could be maintained. No neobladder was removed. In the cases with a fistula, the affected intestinal segment was bypassed. In subneovesical obstruction, a TUR-BT was successfull in 2, chemotherapy in 1 case. 1 patient had an undiversion to a continent pouch. CONCLUSIONS Patients with ileal neobladders were younger, had a lower comorbidity and better tumor stages than patients with other forms of urinary diversion. The risk of tumor-related neobladder complications remained low and could be handled with preservation of the neobladder in almost all cases. Ileal neobladders can be safely offered to patients even with advanced tumor stages, as long as there is no residual tumor visible in the true pelvis at the end of cystectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e580-e581 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bjoern Volkmer Kassel, Germany More articles by this author Karen Czeloth Kassel, Germany More articles by this author Regina Stredele Kassel, Germany More articles by this author Richard Hautmann Ulm, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...