title: [Carcinoma of urachus: report of 15 cases and review of literature--is total cystectomy the treatment of choice for urachal carcinoma?].
abstract: OBJECTIVE
  This study was undertaken to determine the most appropriate type of operation for the improvement of the radical cure rate and QOL of patients with urachal cancer. We assessed the association between the stage, type of operation, and prognosis of cases we experienced and those reported in Japan.
  
  
  METHODS
  The subjects included 15 cases of urachal cancer we have experienced in the past 14 years. While clarifying the clinical patterns of these cases, the association between stage, type of operation, and prognosis was studied. Of the cases of urachal cancer reported in Japan in the recent 20 years, 75 cases in which the stage, type of operation, and prognosis were documented were selected, and the association between the stage and outcome in each type of operation was studied.
  
  
  RESULTS
  In regard to stage, all the cases were rated as more than IIIA. As for prognosis, 9 cases (60%) are alive without cancer at the present time with a mean survival time of 7 years. Of the above patients, 3 underwent cystectomy and 6 underwent en bloc segmental resection (herein after referred to en bloc). Recurrence or cancer death was experienced in 5 patients, 2 of which were classified as stage IIIA and 3 as IIID. Of these patients, one underwent en bloc, 3 partial resection of the bladder, and one underwent exploratory laparotomy. As far as our study of the cases reported in Japan is concerned, the prognosis of the cases having undergone only partial resection of the bladder was poor, while of the cases having undergone en bloc or total cystectomy 88-100% were alive without cancer for more than 2 years if their stage was classified as IIIA or below. On the other hand, prognosis was very poor whatever the type of operation in the cases whose cancer was stage IIIC or above.
  
  
  CONCLUSIONS
  It appears that the en bloc is most appropriate as the type of operation for the cases of urachal cancer and that the application of total cystectomy is limited to some cases. In performing the en bloc, an extensive resection of the peritoneum, resection of the posterior sheath of the rectus muscle of the abdomen, and dissection of the intrapelvic lymph nodes in addition to the conventional types of operation should be carried out positively.
authors.affiliation: Department of Urology, Jikei University School of Medicine.
authors.forename: Koji
authors.initials: K
authors.lastname: Asano
authors.forename: Jun
authors.initials: J
authors.lastname: Miki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamada
authors.forename: Shiegetaka
authors.initials: S
authors.lastname: Maeda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Abe
authors.forename: Akira
authors.initials: A
authors.lastname: Furuta
authors.forename: Masayasu
authors.initials: M
authors.lastname: Suzuki
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Onishi
authors.forename: Akira
authors.initials: A
authors.lastname: Kido
authors.forename: Masataka
authors.initials: M
authors.lastname: Ueda
authors.forename: Makio
authors.initials: M
authors.lastname: Kawakami
authors.forename: Shoichi
authors.initials: S
authors.lastname: Onodera
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Oishi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D014497:Urachus; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery