Ureteral and Urethral Margin Status in Radical Cystectomy Specimens
Zuzana Kos, Farshid Siadat, Eric C Belanger, Bich N Nguyen, Kien T Mai. The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
Background: The status of ureteral and urethral resection margins in radical cystectomy specimens, performed for urothelial carcinoma, is a source of consternation for surgeons and pathologists alike. We correlated margin status with preoperative patient factors and postoperative outcome.
Design: Consecutive radical/total cystectomy specimens for urothelial carcinoma (UC) along with the associated clinical charts were reviewed.
Results: A total of 91 specimens (Male[M]/Female[F]:76/15) were reviewed. The ureters, urethra and their respective resection margins were assessed for both in situ and invasive UC. At least one ureter was involved by in situ UC (ISUC) in 23 cases, and invasive UC in 4 cases. At least one ureteral resection margin (not including subsequent ureteral resections) was involved by ISUC in 5 cases. No invasive UC was present at any of the ureteral margins. The urethra was involved by ISUC in 36 cases, and invasive UC in 21 cases. The urethral resection margin was positive for ISUC in 5 cases and invasive UC in 2 cases.
There were 41 (M/F:38/3) specimens with involvement of either the ureter, urethra or both by in situ or invasive UC, and 8 (M/F:7/1) specimens with either ureteral, urethral or both resection margin involvement.
Of the 41 patients with ureteral/urethral involvement: a) 25 had a history of low grade UC for at least 3 years (mean: 4.5 yrs), with multiple recurrences and resections, including BCG/radiation and chemotherapy in 18 patients. 10 patients subsequently developed high grade UC and 15 patients showed focal to extensive squamous differentiation; b) 9 patients had ISUC resistant to BCG treatment for at least 2 years (mean: 3.5 yrs); and c) 7 patients had no available history.
Of 8 patients with positive resection margins, the 5 patients with positive ureteral margins (all in situ disease), regardless of the status of the urethral margin, were associated with high-stage disease (lymph node metastases in 3 cases) and death due to disease in 0-2 years in 3 patients. The 3 patients with only a positive urethral resection margin, (2 invasive and 1 in situ) had no associated perivesicular tumour extension or lymph node metastasis, and were alive for 1-3 years of follow up.
Conclusions: Patients undergoing radical cystectomy for UC were more likely to have positive ureteral (+/-urethral) resection margins following a protracted history of recurrent low grade UC with multiple resections and presented with advanced stage at radical cystectomy. Cases with only positive urethral resection margins were associated with better clinical outcome.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 140, Wednesday Afternoon