The assessment of bladder cancer resectability with bimanual palpation: A prospective study in laparoscopy and open cystectomy patients

• Published in: Urologic oncology Vol. 42; no. 6; pp. 176.e1 - 176.e7
• Main Authors: Czech, Anna K., Gronostaj, Katarzyna, Frydrych, Jakub, Polok, Kamil, Fronczek, Jakub, Dudek, Przemyslaw, Belch, Lukasz, Chlosta, Marcin, Choragwicki, Dominik, Dymowski, Tomasz, Ostachowski, Mateusz, Piatek-Koziej, Katarzyna, Przydacz, Mikołaj, Pyrkosz, Pawel, Wiatr, Tomasz, Wrozek, Marcin, Chlosta, Piotr L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2024
• Subjects: Aged; Bladder cancer; Cystectomy; Cystectomy - methods; Exam under anesthesia; Female; Humans; Laparoscopy - methods; Male; Margins of excision; Middle Aged; Muscle-invasive bladder cancer; Palpation; Prospective Studies; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Cystectomy; Muscle-invasive bladder cancer; Bladder cancer; Margins of excision; Exam under anesthesia
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2024.02.006

•We evaluated bimanual palpation as a tool in assessing bladder cancer resectability.•Limited mobility of the bladder was noted in 17% of patients undergoing cystectomy.•Surgical margin status in cystectomy specimens was used as a measure of resectability.•Limited mobility of the bladder yielded prognostic information on surgical margins.•Bimanual palpation may offer valuable insights in surgical decision making.
To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy.
This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability. We used multivariable logistic regression models to assess whether EUA performed by blinded or non-blinded examiners is associated with soft tissue positive surgical margins (PSMs) and to calculate the fraction of new information added by such an examination in addition to selected clinical variables.
Among the 134 patients analyzed, limited bladder mobility was indicated by the blinded and non-blinded examiners in 23 (17.2%) and 21 (15.7%) cases, respectively. PSMs were identified in 22 (16.4%) patients, more often in patients with limited bladder mobility as assessed by the blinded (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.9–24.2) and non-blinded examiners (OR 12.9; 95% CI, 2.9–57.5). The fraction of new information added by the blinded and non-blinded examiners was 48.6% and 57.7%, respectively.
The enrichment of patients who underwent pure laparoscopic cystectomy (n = 102; 76%) and the inclusion of patients for emergent surgery may limit the generalizability of our findings.
The identification of limited bladder mobility during preoperative EUA yielded prognostic information on surgical margin status. Our findings suggest that EUA has the potential to provide valuable insights in the assessment of bladder resectability. However, further research in a larger cohort of patients is warranted to validate and expand on these findings.