Bladder-sparing surgery in locally advanced nonurological pelvic malignancy
G Siva Prasad1, K N Chacko, D Antony
1Department of Urology, Christian Medical College, Vellore, India.
Urologia Internationalis
|July 11, 2006
Summary
Bladder-sparing surgery (BSS) is a valid option for locally advanced nonurological pelvic malignancies, potentially improving quality of life. Preoperative imaging and intraoperative findings guide the decision-making process for this approach.
Area of Science:
- Urology
- Surgical Oncology
- Pelvic Malignancies
Background:
- Pelvic malignancies frequently involve the urinary bladder, with locally advanced colorectal cancer showing 5-12% extension.
- Management guidelines for bladder involvement in non-colorectal pelvic malignancies are lacking.
- A clinical dilemma exists between radical cystectomy and bladder-sparing procedures.
Purpose of the Study:
- To evaluate the efficacy and outcomes of bladder-sparing surgery (BSS) in patients with locally advanced nonurological pelvic malignancies.
- To determine the role of preoperative imaging and intraoperative findings in decision-making for BSS.
Main Methods:
- Retrospective review of hospital records for patients undergoing BSS between January 1992 and May 2003.
- Inclusion criteria: patients with locally advanced nonurological pelvic malignancy undergoing BSS.
- Surgical procedures included abdomino-perineal resection, anterior resection, anterior exenteration, debulking, and total pelvic exenteration.
Main Results:
- BSS was performed on 15 patients: 10 with colorectal malignancy, 3 with lateral pelvic wall masses, 1 with ovarian malignancy, and 1 with residual cervical cancer.
- Preoperative CT scans accurately predicted bladder involvement (87.5% sensitivity via cystoscopy).
- Partial cystectomy was performed in 9 patients; 6 required ureteric reimplantation. 50% experienced lower urinary tract symptoms at 1 year. 3-year survival was 40%.
Conclusions:
- Bladder-sparing surgery is feasible for nonurological pelvic malignancies due to non-multifocal disease.
- Preoperative CT/MRI aids in predicting urinary tract involvement, facilitating surgical planning.
- Intraoperative assessment is crucial for the final decision; BSS may enhance quality of life without compromising survival.
