Management Of Transitional Cell Carcinoma Research Articles

Diagnosis and surgical management of transitional cell carcinoma in a dog

Diagnosis and surgical management of transitional cell carcinoma in a dog

A Comparative Study Between Single Dose & Multiple Doses of Mitomycin-C in the Management of Transitional Cell Carcinoma of Urinary Bladder

Objectives: To find out the efficacy of post TURBT immediate single dose adjuvant intravesical Mitomycin C therapy in comparison with multi-dose regimen of Mitomycin C therapy in the management of superficial transitional cell carcinoma of the urinary bladder.
 Methods: Total 76 patients of bladder mass were included in the study who had undergone transurethral resection followed by immediate single instillation of Mitomycin C. After availability of histopathological examination report of resected tumor, those fulfill the selection criteria were randomized into two groups. One group (Group A) was the odd numbers of the patients who already received immediate single intravesical instillation of Mitomycin C and another group (Group B) even number of the patients who received single dose of intravesical instillation of Mitomycin C immediately with additional 5 instillations (1 week interval for 5 weeks) and in whom prospective follow-up could be completed within next 12 months
 Results: The effect of single intravesical instillation of 40 mg of Mitomycin C (Group A) within 24 hours of TURBT with that of multiple doses (six doses) of Mitomycin C (Group B) in similar dose was insignificant.
 Conclusion: The efficacy of MMC single dose was similar to MMC multi-dose regimen with insignificant difference of side effect among the two groups (0% versus 6.25%).
 Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.74-77

MiR-130b, an onco-miRNA in bladder cancer, is directly regulated by NF-κB and sustains NF-κB activation by decreasing Cylindromatosis expression.

Persistent activation of NF-κB signaling is closely related to chronic inflammation and tumorigenesis. Commonly, NF-κB signaling is tightly controlled by multiple feedback loops and regulators, such as the deubiquitinases (DUBs). However, in cancer cells, NF-κB may override these feedbacks through special pathways and lead to the sustained activation. In the present study, we demonstrate that in transitional cell carcinoma (TCC) of bladder, miR-130b plays an oncogenesis role, it enhanced proliferation, invasion and migration of TCC cell, and was highly correlated with tumor progression. On the other hand, NF-κB directly regulated the transcription of miR-130b by binding with its promoter region. Importantly, we verify that, through deceasing the expression of Cylindromatosis (CYLD), a K63-specific DUB and endogenous blocker of NF-κB signaling, miR-130b can in return sustain the persistent activation of NF-κB, which may promote the malignant progression of TCC. Thus, the present study uncovers a potential signaling transduction in which NF-κB is continuously activated, and may provide a novel therapeutic approach for the clinical management of TCC.

Saudi oncology society and Saudi urology association combined clinical management guidelines for urothelial urinary bladder cancer

In this report, updated guidelines for the evaluation, medical, and surgical management of transitional cell carcinoma of the urinary bladder are resented. They are categorized according the stage of the disease using the TNM staging system 7th edition. The recommendations are presented with supporting level of evidence.

Small Animal Review

Introduction: Metronomic therapy with chlorambucil is effective in the management of transitional cell carcinoma in the dog.

Endoscopic Versus Laparoscopic Management of Noninvasive Upper Tract Urothelial Carcinoma: 20-Year Single Center Experience

We compare the outcomes of endoscopic surgery to laparoscopic nephroureterectomy for the management of specifically noninvasive upper tract urothelial carcinoma. A retrospective database review identified consecutive patients with clinically noninvasive upper tract urothelial carcinoma who underwent endoscopic surgery (59, via ureteroscopic ablation or percutaneous resection) or laparoscopic nephroureterectomy (70) at a single center during 20 years (1991 to 2011). Overall survival, upper tract urothelial carcinoma specific survival, upper tract recurrence-free survival, intravesical recurrence-free survival, progression-free survival and renal unit survival were estimated using Kaplan-Meier methods, with differences assessed using the log rank test. Median age and followup were 74.8 years and 50 months, respectively. Overall renal preservation in the endoscopic group was high (5-year renal unit survival 82.5%), although this came at a cost of high local recurrence (endoscopic surgery 5-year recurrence-free survival 49.3%, laparoscopic nephroureterectomy 100%, p <0.0001). For G1 upper tract urothelial carcinoma, endoscopic surgery 5-year disease specific survival (100%) was equivalent to that of laparoscopic nephroureterectomy (100%). However, laparoscopic nephroureterectomy demonstrated superior disease specific survival to endoscopic surgery for G2 disease (91.7% vs 62.5%, p = 0.037) and superior progression-free survival for G3 disease (88.9% vs 55.6%, p = 0.033). For G1 upper tract urothelial carcinoma, endoscopic management can provide effective oncologic control and renal preservation. However, endoscopic management should not be considered for higher grade disease except in compelling imperative cases or in patients with poor life expectancy as oncologic outcomes are inferior to those of laparoscopic nephroureterectomy.

The management of transitional cell carcinoma (TCC) in a European regional renal transplant population

In the West, transitional cell carcinoma (TCC) in renal transplant patients is uncommon, but aggressive. Conversely, it appears to be frequent in the Far East, necessitating aggressive surgical approaches such as prophylactic nephroureterectomy. There are few European case series to date. TCC in the present population was predominantly low-grade and superficial, with no progression in patients with those tumours. Endoscopic management was sufficient for most patients. The behaviour of TCC in the present population was much less aggressive than that described in the Far East. Altering immunosuppression regimes may have a role to play in managing bladder cancer in renal transplant patients. To examine the clinical characteristics, management and long-term outcomes of patients with transitional cell carcinoma (TCC) who also have had renal transplantation. A retrospective case note review was performed for the 15-year period 1995-2009. Searches from three different urological centres in the UK, using multiple sources, yielded 1647 patients with renal transplants, 12 of whom had TCC. Eight cases were identified who developed de novo TCC after transplantation (0.48%). Four patients had pre-existing TCC who then had renal transplantation. The current literature was reviewed. In the eight de novo TCC cases, the bladder was the site in all with no upper tract TCC; seven were superficial (pTa/T1) and five were low grade (G1/2). The mean time to development of TCC after transplant was 5 years, with a mean follow-up of 11 years. There was no progression in low-grade superficial disease that was managed endoscopically. The 5- and 10-year overall survival was 83% and 72%, respectively. In patients with pre-existing TCC prophylactic bilateral nephroureterectomy before transplantation was performed once. There was progression of superficial disease whilst on immunosuppression in one patient. Sirolimus was used in patients with TCC and reports suggest this may have a role to play in modifying malignancy in this setting. The number of patients involved in studies particularly focusing on TCC in renal transplantation is small (136 patients), with 60% from China/Taiwan where there is a high incidence of upper tract TCC and high-grade muscle-invasive disease. Although this is one of the largest European case series of renal transplant patients with TCC, the numbers are small making clear conclusions difficult. The frequency of TCC in our renal transplant population is low, consistent with previous studies. However, contrary to prior studies, TCC after renal transplantation in this European population was predominantly superficial, low-grade, non-progressive and confined to the bladder. Altering immunosuppression regimes in patients with TCC may have a role to play, although further work is required to clarify and substantiate this.

Surgical management of transitional cell carcinoma of the lacrimal sac: Is it time for a new treatment algorithm?

Transitional cell carcinoma (TCC) arising in the lacrimal sac is a rare neoplasm. Despite radical surgery and radiotherapy, these tumors generally have a poor prognosis due to an often late diagnosis, high rate of loco-regional recurrence and mortality. There are only a relatively small number of documented cases of TCC when compared to other epithelial malignancies of the lacrimal drainage system. As would be anticipated, there are currently no evidence-based clinical practice guidelines for the treatment of these lesions. We present an illustrative case and consider the literature in relation to current surgical management of these tumors. We propose an alternate management consideration for these tumors.

High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end‐stage renal disease

This study examines the epidemiology of transitional cell carcinoma (TCC) in end-stage renal disease (ESRD) population from Taiwan, the area with the highest incidence and prevalence of ESRD. A total of 98 out of 10,890 ESRD patients were referred for management of TCC between 2000 and 2008. Demographic, clinical and laboratory data were collected and patient mortality and tumour recurrence rates were analyzed. TCC patients were aged 61.4 ± 10.2 years and 66.3% were female. The average time from initiation of dialysis to tumour detection was 51.2 ± 36.4 months. Hypertensive nephrosclerosis, diabetes mellitus, chronic glomerulonephritis and unknown aetiology accounted for 25.5%, 20.4%, 22.4% and 31.6% of the causes of renal failure, respectively. The aetiology of renal failure for the 31.6% of patients was unclear, but chronic tubulointerstitial nephritis following long-term consumption of Chinese herbs (19.4%) or analgesic compounds (3.1%) was considered in some patients. Almost all (98.0%) patients presented with gross haematuria. Most TCC were in early stage (stage 0, 3.1%; stage I, 56.1%) during diagnosis. At the end of this study, 17 of 98 (17.3%) patients died. Multivariate Cox regression analysis found that age (odds ratio =1.140, 95% confidence interval = 1.049-1.239, P = 0.002) and tumour pain (odds ratio = 0.234, 95% confidence interval = 0.057-0.961, P = 0.044) were significant risk factors for all-cause mortality. Furthermore, 35.7% of TCC recurred during follow up. The 5 year patient and tumour-free survival rates were 72.4% and 14.4%, respectively. The data shows that Taiwanese patients with ESRD had high incidence (0.9%) and recurrence (35.7%) of TCC.

Role of systemic peri-operative chemotherapy in management of transitional cell carcinoma of bladder

Bladder cancer has variable biological behavior pattern in different individuals and the debate regarding peri-operative use of systemic chemotherapy with the surgical management remains. The optimal treatment strategy, regimen and the timing of peri-operative chemotherapy are not yet known. Here we review the existing literature for the use of systemic peri-operative chemotherapy in management of advanced bladder cancer.

Saudi Oncology Society clinical management guidelines for urinary bladder cancer

In this report guidelines for the evaluation, medical and surgical management of transitional cell carcinoma of urinary bladder is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.

Expression profiling for bladder cancer: strategies to uncover prognostic factors

Despite being a common cancer worldwide, management of transitional cell carcinoma of the bladder currently relies primarily on clinical staging and histopathologic parameters. Assaying alterations in molecular pathways can contribute valuable information that can accurately predict outcome and chemotherapeutic response in individual patients with bladder cancer. Medium- to high-throughput gene-expression profiling technologies are now allowing multiplexed assessment of alterations responsible for the genesis and progression of bladder tumors. These investigations employ global or pathway-based approaches to define molecular signatures that can predict prognosis independent of traditional clinical performance metrics. Prognostic panels generated using these strategies can also elucidate the biology of tumor progression and identify potential therapeutic targets.

Bladder cancer: translating molecular genetic insights into clinical practice

Transitional cell (urothelial) carcinoma of the bladder is the second most common urologic malignancy and is one of the best understood neoplasms, with relatively well-defined pathogenetic pathways, natural history, and tumor biology. Conventional clinical and pathologic parameters are widely used to grade and stage tumors and to predict clinical outcome of transitional cell carcinoma; but the predictive ability of these parameters is limited, and there is a lack of indices that could allow prospective assessment of risk for individual patients. In the last decade, a wide range of candidate biomarkers representing key pathways in carcinogenesis have been reported to be clinically relevant and potentially useful as diagnostic and prognostic molecular markers, and as potential therapeutic targets. The use of molecular markers has facilitated the development of novel and more accurate diagnostic, prognostic, and therapeutic strategies. FGFR3 and TP53 mutations have been recognized as key genetic pathways in the carcinogenesis of transitional cell carcinoma. FGFR3 appears to be the most frequently mutated oncogene in transitional cell carcinoma; its mutation is strongly associated with low tumor grade, early stage, and low recurrence rate, which confer a better overall prognosis. In contrast, TP53 mutations are associated with higher tumor grade, more advanced stage, and more frequent tumor recurrences. These molecular markers offer the potential to characterize individual urothelial neoplasms more completely than is possible by histologic evaluation alone. Areas in which molecular markers may prove valuable include prediction of tumor recurrence, molecular staging of transitional cell carcinoma, detection of lymph node metastasis and circulating cancer cells, identification of therapeutic targets, and prediction of response to therapy. With accumulating molecular knowledge of transitional cell carcinoma, we are closer to the goal of bridging the gap between molecular findings and clinical outcomes. Assessment of key genetic pathways and expression profiles could ultimately establish a set of molecular markers to predict the biological nature of tumors and to establish new standards for molecular tumor grading, classification, and prognostication. The main focus of this review is to discuss clinically relevant biomarkers that might be useful in the management of transitional cell carcinoma and to provide approaches in the analysis of molecular pathways that influence the clinical course of bladder cancer.

Management of Transitional Cell Carcinoma of the Lacrimal Sac: A Multidisciplinary Approach to Orbit Sparing Treatment

The LaryngoscopeVolume 120, Issue S4 p. S161-S161 Triological Society 2010 Combined Sections Meeting Poster Session Management of Transitional Cell Carcinoma of the Lacrimal Sac: A Multidisciplinary Approach to Orbit Sparing Treatment Linda N. Lee MD, Linda N. Lee MD Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA Department of Otology & Laryngology, Harvard Medical School, Boston, MASearch for more papers by this authorAndrew R. Scott MD, Andrew R. Scott MD Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA Department of Otology & Laryngology, Harvard Medical School, Boston, MASearch for more papers by this authorAnnie W. Chan MD, Annie W. Chan MD Department of Radiation Oncology, Massachusetts General Hospital, Boston, MASearch for more papers by this authorRobert A. Frankenthaler MD, Robert A. Frankenthaler MD Division of Otolaryngology - Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, MA Department of Otology & Laryngology, Harvard Medical School, Boston, MASearch for more papers by this author Linda N. Lee MD, Linda N. Lee MD Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA Department of Otology & Laryngology, Harvard Medical School, Boston, MASearch for more papers by this authorAndrew R. Scott MD, Andrew R. Scott MD Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA Department of Otology & Laryngology, Harvard Medical School, Boston, MASearch for more papers by this authorAnnie W. Chan MD, Annie W. Chan MD Department of Radiation Oncology, Massachusetts General Hospital, Boston, MASearch for more papers by this authorRobert A. Frankenthaler MD, Robert A. Frankenthaler MD Division of Otolaryngology - Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, MA Department of Otology & Laryngology, Harvard Medical School, Boston, MASearch for more papers by this author First published: 10 January 2011 https://doi.org/10.1002/lary.21625Citations: 12AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume120, IssueS4Supplement: Triological Society 2010 Combined Sections Meeting Poster Session2010Pages S161-S161 RelatedInformation

Second-line therapy in bladder cancer

To review new developments in second-line treatment for transitional cell carcinoma of the urinary bladder focusing on advances and findings within the last year. So far no standard therapy has been established for pretreated patients with transitional cell carcinoma. Prognostic and predictive factors for response and outcome in pretreated patients have been studied retrospectively and will help to identify those who might benefit from intensive therapy and those who would rather improve their quality of life with best supportive care. Single-agent chemotherapy in this setting provided low response rates, short progression-free and overall survival. Vinflunine, a novel vinca-alkaloid, and best supportive care had a modest, but still significant benefit at a very moderate toxicity rate in a randomized phase III trial. As for second-line combination chemotherapy, response rates as well as potential toxicities are higher and the progression-free survival and overall survival benefits are still poorly understood. New chemotherapeutics and approaches like metronomic chemotherapy and novel agents are under investigation. With vinflunine there is reasonable hope for a new standard chemotherapy in second-line management of transitional cell carcinoma. However, due to the reported results with single agents and combination chemotherapy, treatment within clinical trials is still the best choice in patients progressing after first-line chemotherapy.

Imaging and Staging of Transitional Cell Carcinoma: Part 1, Lower Urinary Tract

Transitional cell carcinoma (TCC) of the bladder is one of the most common malignancies affecting the genitourinary tract and is characterized by multifocality and a high incidence of recurrence. Radiologists play an important role in the staging and surveillance of this malignancy. In this article, we discuss the epidemiology, pathologic characteristics, and patterns of tumor spread of bladder carcinomas. We illustrate and focus on the role of imaging in the diagnosis, staging, and surveillance of TCC. The hallmark of TCC is multiplicity and recurrence. Cystoscopy is the method of choice for evaluation of the primary tumor in patients with bladder carcinoma. Imaging acts as an adjunct to accurately stage disease in these patients. Nearly 2-4% of patients with bladder cancer develop upper tract TCC. Hence, surveillance of the upper tract, in which imaging plays a central role, is an important component in the management of TCC. As in every other cancer, we face some limitations in nodal staging of TCC, particularly when the nodes are not enlarged. Development and validation of newer scanning techniques and MR contrast agents may help address some of these limitations in the future.

Management of transitional cell carcinoma of the urinary bladder at Kenyatta National Hospital, Nairobi

To highlight the management of patients with transitional cell carcinoma of the urinary bladder with regards to clinical presentation, treatment and outcome. A retrospective study. Kenyatta National Hospital, Nairobi, Kenya. Fifty two patients who presented at Kenyatta National Hospital over a ten year period with histologically proven transitional cell carcinoma of the urinary bladder. There were 41 males and 11 females aged 27 to 84 years. The mean age was 57 years. An average of 5.2 patients per year were seen. The male to female ratio was 3.7:1. Most common clinical presentations were haematuria 98%, Lower abdominal pains 71%. The main investigative procedures done in these patients included cystoscopy in 71.2%, ultrasound 46.2%, IVU 32.7% among others. The treatment modalities were based on the stage of the disease and included surgery 48.1%, combination therapy in 23.1%, chemotherapy in 5.8% and radiotherapy in 3.8%. Surgery was the mainstay of treatment, cystectomy was done in 26.9% and cystostomy and resection of tumour 26.9%. Other surgical methods carried out were transurethral resection of bladder tumour(TURBT), cystectomy and bladder augumentation, channel transurethral resection, cystectomy and ileocondult. Nine patients (17.3%) were not given any treatment because either the disease was too advanced and died before any treatment was instituted or were lost to follow up. Mortality and outcome of the disease was difficult to assess due to poor follow up, however 65.4% of the patients were still alive, 17.3% had died and 17.3% were lost to follow up by the end of the study period. Haematuria was the most important presenting clinical feature. Poor record keeping may have contributed to the low number of patients enrolled into the study. The TCC in this study was not thoroughly managed. It is suggested that early diagnosis, early surgery and combination of other treatment modalities should improve the outcome. This can only be possible with further training of health personnel, the education of the public and availability of improved diagnostic as well as treatment facilities especially cystoscopes and resectoscopes. There is need for developing proper management protocols for bladder tumours.

RISK FACTORS FOR INTRAVESICAL RECURRENCE FOLLOWING SURGICAL MANAGEMENT OF TRANSITIONAL CELL CARCINOMA OF THE UPPER URINARY TRACT

To identify risk factors for developing subsequent bladder cancer in patients undergoing surgical management of transitional cell carcinoma (TCC) of the upper urinary tract.This study included 177 patients who were diagnosed as having clinically localized upper urinary tract TCC and thereafter underwent nephroureterectomy after exclusion of those with a previous and/or concurrent history of bladder cancer. Univariate and multivariate analyses using both the logistic regression model and the Cox proportional hazards model were carried out in these 177 patients to determine the risk factors for intravesical recurrence after nephroureterectomy.Of the 177 patients, 63 (35.6%) developed recurrent bladder cancer after a median interval of 7.5 months. Intravesical recurrence-free survival rates for these 177 patients at 1, 3, and 5 years were 75.7%, 63.7%, and 54.1%, respectively. Univariate analyses showed that patients with low-stage tumors and those with multifocal tumors were likely to undergo subsequent intravesical recurrence; however, there was no significant impact of other factors on subsequent intravesical recurrence, including age, tumor side, tumor location, surgical modality, operation time, management of the distal ureter, tumor grade, lymph node metastasis, microvascular invasion, lymphatic invasion, and margin status. Furthermore, pathologic stage and tumor multifocality were identified as independent predictors for the development of recurrent bladder cancer by multivariate analyses.The incidence of intravesical recurrence after nephroureterectomy for upper urinary tract TCC is comparatively high. It could be important to perform careful follow-up targeting intravesical recurrence for such patients after nephroureterectomy, particularly those with low-stage tumors and/or multifocal tumors.

Risk Factors for Intravesical Recurrence After Surgical Management of Transitional Cell Carcinoma of the Upper Urinary Tract

To identify risk factors for developing subsequent bladder cancer in patients undergoing surgical management of transitional cell carcinoma (TCC) of the upper urinary tract. This study included 177 patients who were diagnosed as having clinically localized upper urinary tract TCC and thereafter underwent nephroureterectomy after exclusion of those with a previous and/or concurrent history of bladder cancer. Univariate and multivariate analyses using both the logistic regression model and the Cox proportional hazards model were carried out in these 177 patients to determine the risk factors for intravesical recurrence after nephroureterectomy. Of the 177 patients, 63 (35.6%) developed recurrent bladder cancer after a median interval of 7.5 months. Intravesical recurrence-free survival rates for these 177 patients at 1, 3, and 5 years were 75.7%, 63.7%, and 54.1%, respectively. Univariate analyses showed that patients with low-stage tumors and those with multifocal tumors were likely to undergo subsequent intravesical recurrence; however, there was no significant impact of other factors on subsequent intravesical recurrence, including age, tumor side, tumor location, surgical modality, operation time, management of the distal ureter, tumor grade, lymph node metastasis, microvascular invasion, lymphatic invasion, and margin status. Furthermore, pathologic stage and tumor multifocality were identified as independent predictors for the development of recurrent bladder cancer by multivariate analyses. The incidence of intravesical recurrence after nephroureterectomy for upper urinary tract TCC is comparatively high. It could be important to perform careful follow-up targeting intravesical recurrence for such patients after nephroureterectomy, particularly those with low-stage tumors and/or multifocal tumors.

Pneumoperitoneum with Carbon Dioxide Inhibits Macrophage Tumor Necrosis Factor-α Secretion: Source of Transitional-Cell Carcinoma Port-Site Metastasis, with Prophylactic Irrigation Strategies to Decrease Laparoscopic Oncologic Risks

Peritoneal macrophages play a critical role in maintaining local host resistance to infection and malignancy through the secretion of tumor necrosis factor-alpha (TNF-alpha). We hypothesized that attenuated TNF-alpha secretion, as a result of CO(2) pneumoperitoneum, could alter local immune surveillance, thereby contributing to the development of carcinomatosis and incisional metastasis. We further sought to determine if port-site metastasis could be prevented with prophylactic irrigants. C57BL/6 mice (n = 50) and the syngenic murine bladder tumor (MBT-2) cell line were used. Experiment 1: Mice were subjected to either CO(2) pneumoperitoneum at 6 mm Hg (n = 10) or a 3-cm midline incision (n = 10). Peritoneal macrophages (1 x 10(6)/animal) were collected and subjected to lipopolysaccharide challenge. TNF-alpha levels were quantified using the Quantikine Mouse TNF-alpha/TNFSF1A Immunoassay. Experiment 2: Peritoneal and port-site metastasis were evaluated 1 week after 1 x 10(6) MBT-2 cells/animal were spilled in an open group (n = 5) and through 5-mm trocars of a pneumoperitoneal group (n = 5). Experiment 3: 1 x 10(6) MBT-2 cells/animal were spilled intraperitoneally through 5-mm trocars of four groups (n = 20). Port sites in each group were then irrigated with either sterile water, mitomycin C (1.0 mg/mL), betadine (10%), or heparin (1000 U/mL). At 1 week, incisional sites were evaluated for gross and microscopic metastasis. In each experiment, Student t-test was used to quantify statistical differences. Peritoneal macrophage TNF-alpha secretion was significantly inhibited in mice subjected to CO(2) pneumoperitoneum v control at 10 and 20 minutes (P = 0.015, P = 0.001, respectively). When 1 x 10(6) MBT-2 cells were spilled, a significantly higher average tumor burden developed in animals subjected to CO(2) pneumoperitoneum than in controls at 1 week (9.2 gm v 3.8 g, P = 0.002). All irrigants prevented the development of port-site metastasis, yet sterile water did so without toxic effect. In a syngenic murine model, CO(2) pneumoperitoneum causes inhibition of peritoneal macrophage TNF-alpha secretion. Heavier intraperitoneal and incisional metastasis develops in C57BL/6 mice subjected to CO(2) pneumoperitoneum and a tumor challenge with 1 x 10(6) MBT-2 tumor cells compared with open controls. Inhibition of peritoneal macrophage TNF-alpha secretion may be considered an adverse event contributing to the development of transitional-cell carcinoma (TCC) port-site metastasis, especially if surgical oncologic principles are violated. Irrigating trocar sites and the peritoneal cavity with sterile water at the conclusion of laparoscopic nephroureterectomy and laparoscopic radical cystectomy may offer a safe prophylactic strategy to prevent this unfavorable event. Our murine model presents a novel avenue for the development of adjunct immunomodulatory therapies to perhaps further reduce oncologic risks during laparoscopic management of TCC.