Die Ileum-Neoblase bei Frauen: Eine retrospektive Analyse des onkologischen Outcomes anhand histopathologischer Parameter
Purpose: It was the purpose of this study to assess long-term clinical and oncological outcome in women undergoing radical cystectomy and ileal neobladder reconstruction for invasive ybladder cancer, particularly regarding the influence of tumor localisation at the urethral recurrence rate. Methods: From 1995 to 2010, in the Department of Urology of the University of Ulm a total of 121 women with urothelial carcinoma underwent radical cystectomy with an orthotopic ileal neobladder. The median follow-up was 57 months (mean: 66 months). Clinical course, pathological and oncological outcome of these women were analysed retrospectively. Results: Pathological subgroups included 61 patients (55.5 %) with organ confined, lymph node-negative tumors (<= pT2 N0), 21 (19.1 %) with extravesical, lymph node-negative disease (>= pT3 N0) and 28 (25.5 %) patients with lymph node-positive disease (pTx N+). The 5-/10-year overall survival rate in patients with organ confined (<=pT2 pN0), locally advanced (>=pT3 pN0), and metastatic disease (pTx N+) was 83.3 %/70.3 %, 70.2 %/61.4 %, and 42.3 /17.4 %, respectively. 33 women (34 %) experienced recurrences, 7 (7.2 %) of them a local one, 25 (25.8 %) of them distant metastases. In 8 patients tumor (6,7 %) was located close to the urethra, in 6 of them (5 %) at the trigonum and in 2 (1,7 %) at the bladder neck. None of them developed an urethral recurrence. One patient presented with an urethral recurrence (1 %), in which case tumor was located at the rear of the bladder. Conclusions: Radical cystectomy with orthotopic diversion in female patients with bladder cancer is associated with excellent oncological outcome which is comparable with that in men thus it may be considered a standard therapeutic option in women as well. The risk of urethral recurrence is very low and a tumor localisation close to the urethra is no contraindication for orthotopic diversion if intraoperative frozen section shows no malignancy at the distal urethral margin.
Subject HeadingsBlasenkrebs [GND]
Urinary bladder neoplasms [MeSH]
Urologic neoplasms [MeSH]