Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease

Thomas J. Guzzo, Craig G. Rogers, Chris Y. Deng, Trinity J. Bivalacqua, Ganesh S. Palapattu, Patrick J. Bastian, Mario A. Eisenberger, Mark P. Schoenberg, Mark L. Gonzalgo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES: To assess the clinical outcome of patients with bladder cancer who underwent attempted radical cystectomy (RC) with curative intent, but whose procedures were aborted due to intraoperative findings of metastatic disease, as the presence of metastatic disease at RC is associated with a poor prognosis and there are no data on the optimum management strategy in this situation. PATIENTS AND METHODS: In all, 248 consecutive patients with bladder cancer had attempted RC at one academic institution between 1994 and 2003. We retrospectively reviewed the records of 35 patients who had an aborted RC due to intraoperative findings of metastatic disease. The pathological characteristics, time to recurrence, overall survival, disease-specific survival, and suitability for adjuvant or salvage therapies were examined. RESULTS: Of the 35 patients who had an aborted RC for metastatic disease, 21 (60%) died from the disease within the study period (median time to cancer-specific death 26.4 months), 11 (31%) are alive with evidence of persistent disease or progression, and three (9%) are alive with no evidence of recurrence or progression. Seven patients had a salvage RC after successful adjuvant treatment, of whom three died from recurrent disease (at a mean of 46.5 months after initial exploration, 31.9 months after salvage RC), one is alive with bladder cancer recurrence to the rectum 10 months after salvage cystectomy, and three have no evidence of disease progression at a mean of 10 months after salvage RC. CONCLUSIONS: The prognosis of patients who undergo an aborted attempt at curative RC due to intraoperative findings of metastatic disease is poor. Although a few patients might subsequently have salvage RC, many of these patients still have poor outcomes even if adjuvant treatments are used. When metastatic disease is discovered at RC, completing the cystectomy should be considered, although further studies are needed to show a clinical benefit.

Original languageEnglish (US)
Pages (from-to)1539-1543
Number of pages5
JournalBJU International
Volume102
Issue number11
DOIs
StatePublished - Dec 2008
Externally publishedYes

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Cystectomy
Urinary Bladder Neoplasms
Recurrence
Disease Progression
Salvage Therapy
Survival
Rectum

Keywords

  • Bladder cancer
  • Metastasis
  • Radical cystectomy
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

Guzzo, T. J., Rogers, C. G., Deng, C. Y., Bivalacqua, T. J., Palapattu, G. S., Bastian, P. J., ... Gonzalgo, M. L. (2008). Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease. BJU International, 102(11), 1539-1543. https://doi.org/10.1111/j.1464-410X.2008.07877.x

Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease. / Guzzo, Thomas J.; Rogers, Craig G.; Deng, Chris Y.; Bivalacqua, Trinity J.; Palapattu, Ganesh S.; Bastian, Patrick J.; Eisenberger, Mario A.; Schoenberg, Mark P.; Gonzalgo, Mark L.

In: BJU International, Vol. 102, No. 11, 12.2008, p. 1539-1543.

Research output: Contribution to journalArticle

Guzzo, TJ, Rogers, CG, Deng, CY, Bivalacqua, TJ, Palapattu, GS, Bastian, PJ, Eisenberger, MA, Schoenberg, MP & Gonzalgo, ML 2008, 'Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease', BJU International, vol. 102, no. 11, pp. 1539-1543. https://doi.org/10.1111/j.1464-410X.2008.07877.x
Guzzo, Thomas J. ; Rogers, Craig G. ; Deng, Chris Y. ; Bivalacqua, Trinity J. ; Palapattu, Ganesh S. ; Bastian, Patrick J. ; Eisenberger, Mario A. ; Schoenberg, Mark P. ; Gonzalgo, Mark L. / Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease. In: BJU International. 2008 ; Vol. 102, No. 11. pp. 1539-1543.
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abstract = "OBJECTIVES: To assess the clinical outcome of patients with bladder cancer who underwent attempted radical cystectomy (RC) with curative intent, but whose procedures were aborted due to intraoperative findings of metastatic disease, as the presence of metastatic disease at RC is associated with a poor prognosis and there are no data on the optimum management strategy in this situation. PATIENTS AND METHODS: In all, 248 consecutive patients with bladder cancer had attempted RC at one academic institution between 1994 and 2003. We retrospectively reviewed the records of 35 patients who had an aborted RC due to intraoperative findings of metastatic disease. The pathological characteristics, time to recurrence, overall survival, disease-specific survival, and suitability for adjuvant or salvage therapies were examined. RESULTS: Of the 35 patients who had an aborted RC for metastatic disease, 21 (60{\%}) died from the disease within the study period (median time to cancer-specific death 26.4 months), 11 (31{\%}) are alive with evidence of persistent disease or progression, and three (9{\%}) are alive with no evidence of recurrence or progression. Seven patients had a salvage RC after successful adjuvant treatment, of whom three died from recurrent disease (at a mean of 46.5 months after initial exploration, 31.9 months after salvage RC), one is alive with bladder cancer recurrence to the rectum 10 months after salvage cystectomy, and three have no evidence of disease progression at a mean of 10 months after salvage RC. CONCLUSIONS: The prognosis of patients who undergo an aborted attempt at curative RC due to intraoperative findings of metastatic disease is poor. Although a few patients might subsequently have salvage RC, many of these patients still have poor outcomes even if adjuvant treatments are used. When metastatic disease is discovered at RC, completing the cystectomy should be considered, although further studies are needed to show a clinical benefit.",
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author = "Guzzo, {Thomas J.} and Rogers, {Craig G.} and Deng, {Chris Y.} and Bivalacqua, {Trinity J.} and Palapattu, {Ganesh S.} and Bastian, {Patrick J.} and Eisenberger, {Mario A.} and Schoenberg, {Mark P.} and Gonzalgo, {Mark L.}",
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T1 - Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease

AU - Guzzo, Thomas J.

AU - Rogers, Craig G.

AU - Deng, Chris Y.

AU - Bivalacqua, Trinity J.

AU - Palapattu, Ganesh S.

AU - Bastian, Patrick J.

AU - Eisenberger, Mario A.

AU - Schoenberg, Mark P.

AU - Gonzalgo, Mark L.

PY - 2008/12

Y1 - 2008/12

N2 - OBJECTIVES: To assess the clinical outcome of patients with bladder cancer who underwent attempted radical cystectomy (RC) with curative intent, but whose procedures were aborted due to intraoperative findings of metastatic disease, as the presence of metastatic disease at RC is associated with a poor prognosis and there are no data on the optimum management strategy in this situation. PATIENTS AND METHODS: In all, 248 consecutive patients with bladder cancer had attempted RC at one academic institution between 1994 and 2003. We retrospectively reviewed the records of 35 patients who had an aborted RC due to intraoperative findings of metastatic disease. The pathological characteristics, time to recurrence, overall survival, disease-specific survival, and suitability for adjuvant or salvage therapies were examined. RESULTS: Of the 35 patients who had an aborted RC for metastatic disease, 21 (60%) died from the disease within the study period (median time to cancer-specific death 26.4 months), 11 (31%) are alive with evidence of persistent disease or progression, and three (9%) are alive with no evidence of recurrence or progression. Seven patients had a salvage RC after successful adjuvant treatment, of whom three died from recurrent disease (at a mean of 46.5 months after initial exploration, 31.9 months after salvage RC), one is alive with bladder cancer recurrence to the rectum 10 months after salvage cystectomy, and three have no evidence of disease progression at a mean of 10 months after salvage RC. CONCLUSIONS: The prognosis of patients who undergo an aborted attempt at curative RC due to intraoperative findings of metastatic disease is poor. Although a few patients might subsequently have salvage RC, many of these patients still have poor outcomes even if adjuvant treatments are used. When metastatic disease is discovered at RC, completing the cystectomy should be considered, although further studies are needed to show a clinical benefit.

AB - OBJECTIVES: To assess the clinical outcome of patients with bladder cancer who underwent attempted radical cystectomy (RC) with curative intent, but whose procedures were aborted due to intraoperative findings of metastatic disease, as the presence of metastatic disease at RC is associated with a poor prognosis and there are no data on the optimum management strategy in this situation. PATIENTS AND METHODS: In all, 248 consecutive patients with bladder cancer had attempted RC at one academic institution between 1994 and 2003. We retrospectively reviewed the records of 35 patients who had an aborted RC due to intraoperative findings of metastatic disease. The pathological characteristics, time to recurrence, overall survival, disease-specific survival, and suitability for adjuvant or salvage therapies were examined. RESULTS: Of the 35 patients who had an aborted RC for metastatic disease, 21 (60%) died from the disease within the study period (median time to cancer-specific death 26.4 months), 11 (31%) are alive with evidence of persistent disease or progression, and three (9%) are alive with no evidence of recurrence or progression. Seven patients had a salvage RC after successful adjuvant treatment, of whom three died from recurrent disease (at a mean of 46.5 months after initial exploration, 31.9 months after salvage RC), one is alive with bladder cancer recurrence to the rectum 10 months after salvage cystectomy, and three have no evidence of disease progression at a mean of 10 months after salvage RC. CONCLUSIONS: The prognosis of patients who undergo an aborted attempt at curative RC due to intraoperative findings of metastatic disease is poor. Although a few patients might subsequently have salvage RC, many of these patients still have poor outcomes even if adjuvant treatments are used. When metastatic disease is discovered at RC, completing the cystectomy should be considered, although further studies are needed to show a clinical benefit.

KW - Bladder cancer

KW - Metastasis

KW - Radical cystectomy

KW - Survival

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