You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2016MP38-05 TUMOR DISSEMINATION DURING ROBOT-ASSISTED RADICAL CYSTECTOMY: DOES THE EMPEROR HAVE NO CLOTHES? Ahmed Hussein, Yingyu Ma, Gissou Azabdaftari, Nobuyuki Hinata, Wei Luo, Victoria Cranwell, Brittany Bunch, Justen Kozlowski, Sean Glenn, Song Liu, Candace Johnson, and Khurshid Guru Ahmed HusseinAhmed Hussein More articles by this author , Yingyu MaYingyu Ma More articles by this author , Gissou AzabdaftariGissou Azabdaftari More articles by this author , Nobuyuki HinataNobuyuki Hinata More articles by this author , Wei LuoWei Luo More articles by this author , Victoria CranwellVictoria Cranwell More articles by this author , Brittany BunchBrittany Bunch More articles by this author , Justen KozlowskiJusten Kozlowski More articles by this author , Sean GlennSean Glenn More articles by this author , Song LiuSong Liu More articles by this author , Candace JohnsonCandace Johnson More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.109AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Local recurrence remains a major cause of cancer-specific mortality following radical cystectomy. We sought to investigate tumor dissemination in the operative field and contribution of pneumoperitoneum during robot-assisted radical cystectomy (RARC). METHODS Six RARCs were included. Four pelvic irrigations with 0.9% normal saline were performed; Sample I: before RARC; Sample II: after RARC; Sample III: after pelvic lymph node dissection [PLND], and leftover irrigation fluid at end of procedure (Sample IV). CO2 used for pneumoperitoneum was filtered using surgical smoke plume evacuation device. Filter was then removed, washed with 0.9% saline, centrifuged and sediment was analyzed. Intra-vesical bladder irrigations were performed for 3 patients. Methodology: pelvic irrigations (SI-IV) were examined for cytology using thin preparation and cell block by a Genito-Urinary Pathologist/Cytopathologist. Meanwhile, intra-vesical wash, pelvic irrigation, and filter sediment were analyzed for mRNA expression of bladder cancer related genes. mRNA expression was examined by qRT-PCR, with human bladder cancer cell line 253J and GAPDH (controls). Epithelial cell markers EpCAM, cytokeratins 8, 18 and 19 were also assessed. Bladder cancer gene panels used in the Cxbladder Detect urinary test were also examined (CDK1, MDK, IGFBP5, HOXA13 and CXCR2). RESULTS Four patients received neoadjuvant chemotherapy. The mean operative time was 300 minutes. Four patients had pT1 disease, 2 had pT2 disease. All patients had negative soft tissue surgical margins and mean LNY was 31. One patient had positive lymph nodes. No spillage of tumor cells or inadvertent entry into the bladder was observed. All lymph nodes were removed in specimen bags. Cytology: Pelvic Irrigation showed mostly blood, inflammatory, mesothelial cells and macrophages. All specimens were negative for malignant cells. mRNA expression: Bladder cancer related mRNA was detected in the intra-vesical wash and 253J bladder cancer cells (control). In contrast, all pelvic irrigations and filter sediment had very low or undetectable mRNA levels. However, in patient with node positive disease, SI irrigation showed many epithelial markers (KRT8, 18, 19, IGFBP5). CONCLUSIONS Our preliminary analysis showed that bladder cancer cells, bladder cancer related genes and epithelial markers were not present in pelvic irrigation but in intra-vesical wash. These cells were detected in the pelvis in 1 patient with advanced disease. Active enrollment in this study continues which will allow better understanding of local spread of bladder cancer. © 2016FiguresReferencesRelatedDetailsCited byHussein A, Saar M, May P, Wijburg C, Richstone L, Wagner A, Wilson T, Yuh B, Redorta J, Dasgupta P, Khan M, Menon M, Peabody J, Hosseini A, Gaboardi F, Mottrie A, Rha K, Hemal A, Stockle M, Kelly J, Maatman T, Canda A, Wiklund P and Guru K (2016) Early Oncologic Failure after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 197, NO. 6, (1427-1436), Online publication date: 1-Jun-2017. Volume 195Issue 4SApril 2016Page: e534-e535 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmed Hussein More articles by this author Yingyu Ma More articles by this author Gissou Azabdaftari More articles by this author Nobuyuki Hinata More articles by this author Wei Luo More articles by this author Victoria Cranwell More articles by this author Brittany Bunch More articles by this author Justen Kozlowski More articles by this author Sean Glenn More articles by this author Song Liu More articles by this author Candace Johnson More articles by this author Khurshid Guru More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...