slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Introduction Australia as well as US and Europe have significantly higher rates of bladder cancer PowerPoint Presentation
Download Presentation
Introduction Australia as well as US and Europe have significantly higher rates of bladder cancer

Loading in 2 Seconds...

play fullscreen
1 / 1

Introduction Australia as well as US and Europe have significantly higher rates of bladder cancer - PowerPoint PPT Presentation


  • 86 Views
  • Uploaded on

No. 076. A 10-year Histopathological Audit of Radical Cystectomy in a Single Pathology Centre in New South Wales, Australia. Nariman Ahmadi , Warick J Delprado , Andrew J Brooks, Phillip C Brenner, Alexander Grant, Graham M Coombes, Manish I. Patel

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Introduction Australia as well as US and Europe have significantly higher rates of bladder cancer' - ally


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

No. 076

A 10-year Histopathological Audit of Radical Cystectomy in a Single Pathology Centre in New South Wales, Australia

NarimanAhmadi, Warick J Delprado, Andrew J Brooks, Phillip C Brenner, Alexander Grant, Graham M Coombes, Manish I. Patel

Urological Cancer Outcomes Centre, University of Sydney, Discipline of Surgery, NSW, Australia

  • Introduction
  • Australia as well as US and Europe have significantly higher rates of bladder cancer
  • Australia is also thought to have lower survival rates when compared to North America and Europe, especially in females1
  • Radical cystectomy (RC) is the recommended treatment for muscle invasive as well as high risk non-muscle invasive bladder cancers
  • Quality of resection and surgical factors such as soft tissue margins and pelvic node dissection are important predictors of outcome 2,3
  • There are very few publications from Australia especially NSW
  • Results
  • Of 201 patients, 184 had radical cystectomy (RC) and 17 had partial cystectomy (PC)
  • Male to female ratio was 3:1 (148:53)
  • Mean age was 68 with equal sex distribution. Age range was 37-89 yrs.
  • TCC 197(98%), Small cell carcinoma 2(1%), Adenocarcinoma 2(1%)
  • Histological features of the specimen are summarized in Table 1
  • Tumour stage: CIS: 29 (14%), Tx/To/Ta: 5 (2), T1: 24 (12%), T2: 49 (24%), T3: 58 (29%), T4: 36 (18%)
  • Tumour was multifocal in 125 (62%), with CIS alone in 92 (46%), papillary urothelial carcinoma (PUC) alone in 4 (2%), CIS and PUC in 29 (14%)
  • Node stage: N0:105(52%), N1: 9(5%), N2: 21(10%), N3: 2(1%), Nx: 63(31%)
  • Higher tumour stage was associated with higher nodal status (Table 2)
  • Pelvic node dissection was not performed in 55 (30%) of RC, and 8 (47%) of PC. Only 32 (17%) of patients had 10 or more nodes harvested
  • Improving trends of nodal dissection count were noted (Graph 1)
  • Main soft tissue surgical margin was positive in 30 (15%) of specimen
  • More than half of these patients were in the first 3 years of study period
  • Intraoperative frozen section was performed in 123 (67%) of patients
  • Ureteric and urethral margin were positive in 21 (11.5%)
  • and 15 (7.5%) respectively
  • Aim
  • To assess pathological pattern of primary bladder cancer at the time of radical cystectomy
  • To assess the quality of surgical resection in radical cystectomy in NSW, Australia

Table 1. Histological characteristics of the cystectomy specimen (1998-2008)

  • Methods
  • Database of a major pathological centre (DHM) was reviewed for a period of 10 years (1998-2008)
  • Ethics approval was obtained from NSW Ethics Committee
  • Histopathological and surgical features of the specimen were entered in a database format
  • These include: tumour type, grade, stage, lymphovascular invasion, multifocal disease, nodal status, count and density, soft tissue margin as well as urethra/ureteric margins and performance of intra operative frozen section
  • Staging was based on 2009 TNM classification and grading was based on ISUP/WHO 2004 classification
  • The data was then analysed using statistical software SPSS (SPSS Inc, IBM, Version 19)

Table 2:Tumor stage and nodal status at the time of cystectomy (1998-2008)

Graph 1: Trends of pelvic lymph node count in radical cystectomy in NSW (1998-2008)

  • Conclusions
  • Similar male to female ratio was observed in our NSW series
  • Tumour stage at time of cystectomy was similar to other international series 4
  • Higher soft tissue positive surgical margin was observed
  • Significant percentage of patients did not undergo pelvic nodal dissection
  • Low pelvic lymph node count was seen throughout the 10-year study period
  • Improving trends in both nodal count and soft tissue margin positive rates were observed during the 10 years
  • References
  • Tracey E, et al. Bladder cancer survival in New South Wales, Australia: why do women have poorer survival than men? BJU Int. 2009;104: 498-504
  • Herr HW, et al. Pathologic evaluation of radical cystectomy specimen. Cancer 2004; 100: 2470-5
  • Hadjizacharia P, et al. The impact of positive soft tissue surgical margins following radical cystectomy for high grade, invasive bladder cancer. World J Urol 2009; 27:33-8
  • Shariat SF, et al. International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int. 2010; 105:1402-12

Acknowledgements

There are no conflict of interest

Author would like to acknowledge the staff of Douglas Hanly Moir for their help in facilitating data collection