Defining Good Candidates for Extraperitoneal Cystectomy: Results From Random Peritoneum Biopsies of 136 Cases - 27/03/13

Doi : 10.1016/j.urology.2012.11.057

Yi-Ping Zhu ^a,^b, Ding-Wei Ye ^a,^b,^⁎ , Xu-Dong Yao ^a,^b, Shi-Lin Zhang ^a,^b, Bo Dai ^a,^b, Yi-Jun Shen ^a,^b, Chao-fu Wang ^b,^c
^a Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
^b Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
^c Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China

Reprint requests: Ding-Wei Ye, M.D., Fudan University Shanghai Cancer Center, Department of Urology, Department of Oncology, No. 270 Dong an Road, Shanghai, 200032, People’s Republic of China.

Abstract

Objective

To define who are good candidates for extraperitoneal cystectomy.

Methods

Between April 2009 and April 2012, 136 consecutive patients (median age 63.8 years, range 35-87 years) scheduled for transperitoneal radical cystectomy were included in this study. After the bladder was removed, the peritoneum covering the bladder was detached. Any suspicious macroscopic abnormalities on the peritoneum were sampled and examined. A 6-8 point random biopsy of the peritoneum was performed for patients without gross macroscopic abnormality.

Results

The study group consisted of 41 patients with pT1, 48 patients with pT2, 34 patients with pT3, and 13 patients with pT4. The transitional cell carcinoma (TCC) group consisted of 123 of 136 patients (90.4%) and nonurothelial histologies of 13 of 136 patients (9.6%). In general, 8 of 136 patients (5.9%) and 14 of 816 biopsies (1.7%) were confirmed positive for peritoneum biopsies. Among them, 0 of 89 patients with pT1/2, 5 of 34 patients with pT3 (14.7%), and 3 of 13 patients with pT4 (23.1%) had positive biopsies (P <.001). In addition, 5 of 123 patients (4.9%) with TCC, 1 of 7 patients (14.3%) with adenocarcinoma, 1 of 2 patients (50%) with sarcomatoid carcinoma, and 1 of 2 patients (50%) with small cell tumors had positive peritoneum biopsies (P = .006). Among patients with positive lymph nodes, 5 of 34 patients (14.7%) had positive biopsies, compared with 3 of 102 patients (2.9%) in the lymph node-negative group (P = .012).

Conclusion

We found that tumor stage and lymph node status are independent predictors of peritoneal involvement. Extraperitoneal cystectomy should be performed with great caution, only indicated for those patients who have a high likelihood of stage pT1 and pT2. However, patients with cT2-4, positive lymph nodes, or nonurothelial histologies should not have the peritoneum covering the bladder preserved.

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