Abstract
ABSTRACTIntroduction:Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied. The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recur- rence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder.Materials and Methods:From 1985 to 2012, a prospectively maintained institutional blad- der cancer registry was queried for vaginal cuff recurrence post radical cystectomy. Over- all mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of recurrence. Comparisons were performed using the log-rank test. Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence.Results:From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving ei- ther a local or distant site, and 305 patients (65%) had no evidence of recurrence. The 5-year overall mortality-free survival rate was 32.4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence. Cancer-specific mortality-free survival rate was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence. Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginec- tomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.077-6.249]) were independently associated with vaginal cuff recurrence.Conclusion:Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence. Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management.Patient Summary:Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.
Highlights
Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, it has never been studied
Female patients with aggressive disease can be treated with anterior pelvic exenteration, which includes cystectomy, bilateral ibju | Female sparing surgery and vaginal cuff recurrence pelvic lymph node dissection, hysterectomy, bilateral salpingo-oophorectomy, and resection of the upper third of the anterior vaginal wall [2]
Vaginal cuff recurrence was detected in 34 patients (7.3%)
Summary
Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, it has never been studied. A better understanding of this particular site of recurrence would optimize female patient selection, counseling for reproductive organ preservation, and indication for orthotopic neobladder, with the purpose of improving quality of life and preserving sexual health. In response to these needs, our primary aim is to assess the incidence, overall survival, and cancer-specific survival rates for patients with vaginal cuff recurrence following radical cystectomy. The secondary aim is to identify possible independent predictors of bladder cancer recurrence in the vaginal cuff
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