2008 Annual Meeting Abstracts

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The Significance of Ureteral Abnormalities at the Time of Radical Cystectomy
Andrew Harris¹, William Huang², Daniel Canter¹, Thomas Guzzo¹, Meredith Bergey*¹, Seema Somad¹, John Tomaszewski¹, Keith Van Arsdalen¹, Bruce Malkcowicz^1
1Hospital of the University of Pennsylvania, Philadelphia, PA;²Lahey Clinic, Burlington Clinic, MD

Introduction: Frozen sections of ureteral margins (UM) are routinely obtained at the time of radical cystectomy (RC) to attempt a cancer free ureto-intestinal anastomosis, evidence suggests this may not affect survival. Our goal was to determine the incidence of ureteral abnormalities at RC and assess its impact on clinical outcomes.
Methods: We retrospectively reviewed a prospectively maintained RC database from our institution. Patients with ureteral abnormalities ranging from atypia to carcinoma in-situ (CIS) were identified by frozen section analysis. Univariate cox regression analysis and Kaplan-Meier survival curves were constructed to evaluate the effect of abnormal ureteral frozen sections on patient survival
Results: Forty-seven out of 284 (16.5%) patients were identified having ureteral abnormalities: 18 CIS, 18 dysplasia, and 11 TCC. There was no significant difference in 5 and 10-year overall survival (OS) and disease specific survival (DSS) between patients with abnormal UMs and normal UMs (p=0.66, p=0.71).
Nine of the 284 (3.1%) patients in our analysis developed upper urinary tract recurrences (UUTRs). Two had CIS at the time of frozen section analysis, 2 dysplasia, and 5 normal margins. Four of the 47 (8.5%) patients with abnormal UMs had UUTRs compared to 5 of the 237 (2.1%) patients with normal UMs.
Conclusions:Abnormal UMs at time of RC does not appear to effect survival. The incidence of UUTRs was higher in patients with abnormal UMs. This suggests patients with abnormal UMs at the time of RC need closer upper urinary tract follow-up than patients with normal UMs.

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