Treatment and outcomes of urethral recurrence after orthotopic neobladder replacement in patients with bladder cancer — practice in a single centre

• Published in: Journal of international medical research Vol. 46; no. 9; pp. 3928 - 3937
• Main Authors: Zhou, Xiaozhou, Ji, Huixiang, Zhang, Heng, Xiong, Tailin, Pan, Jinhong, Chen, Zhiwen
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-09-2018; Sage Publications Ltd; SAGE Publishing
• Subjects: Adult; Aged; Aged, 80 and over; Bladder cancer; Cancer therapies; Carcinoma, Transitional Cell - secondary; Carcinoma, Transitional Cell - surgery; Clinical Research Reports; Cystectomy; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Reconstructive Surgical Procedures - adverse effects; Reoperation; Retrospective Studies; Survival Analysis; Treatment Outcome; Urethral Neoplasms - secondary; Urethral Neoplasms - surgery; Urinary Bladder - pathology; Urinary Bladder - surgery; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary Diversion - adverse effects; cystectomy; Orthotopic neobladder; survival analysis; bladder cancer; urethral recurrence; urothelial cancer; urethra; urinary diversion
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060518782015

Objectives
To report on the treatment of urethral recurrence after orthotopic urinary diversion at our institution.
Methods
We retrospectively reviewed clinical information of urethral recurrence in patients who underwent radical cystectomy and orthotopic urinary diversion between January 1998 and January 2013.
Results
Of 341 patients, 282 presented for follow-up (median follow-up: 56 months; range: 1–174 months). Eight patients developed local recurrence of urothelial cancer after radical cystectomy. The rate of urethral recurrence (1.4%) in female patients who underwent orthotopic urinary diversion was lower than in male patients (3.3%). The median (range) time to recurrence was 33 (6–120) months after radical cystectomy and orthotopic urinary diversion. Recurrences were treated by transurethral resection of tumour, urethrectomy, neobladder resection, revision of urinary diversion, adjuvant chemotherapy, or radiation therapy, based on individual circumstances. Survival analysis showed that 5-year cancer-specific survival was significantly higher in patients with urethral recurrence alone (83.3%), compared with patients with other recurrences, including pelvic/abdomen recurrence and distant metastasis (26.8%).
Conclusions
En bloc urethrectomy and revision of urinary diversion remain the principle surgical choices. Selection of transurethral tumour resection was based on tumour stage and was used in carefully chosen patients. Cancer-specific survival might depend on multidisciplinary therapy.