title: Significance of cancer involvement at the ureteral margin detected on routine frozen section analysis during radical cystectomy.
abstract: BACKGROUND
  We investigated the clinical significance of preoperatively-unsuspected ureteral involvement of cancer detected on intraoperative frozen section analysis of ureteral margins during radical cystectomy.
  
  
  METHODS
  We performed a retrospective study of 115 patients who received radical cystectomy for locally-advanced but node-negative transitional cell carcinoma of the bladder between 1995 and 2002 by reviewing their records.
  
  
  RESULTS
  Of 115 total patients, 5 (4.3%) demonstrated carcinoma in situ at the ureteral margin with 2 of 5 having a positive margin on final pathologic analysis. Meanwhile, only 3 of 115 total patients (2.6%) later showed upper urinary tract recurrence at a median interval of 30 months after cystectomy. And all 3 patients had intramural or juxtavesical ureter involvement of disease (p = 0.006), while not demonstrating carcinoma in situ in ureteral margins resected during cystectomy. On multivariate analysis, only the stage and grade of bladder cancer along with pathologic feature of vascular invasion were observed to be independent prognostic predictors of disease-specific survival.
  
  
  CONCLUSIONS
  Cancer involvement of the distal ureteral margin detected through intraoperative frozen section analysis may not be a significant factor regarding upper tract recurrence and survival of patients with locally-advanced bladder cancer after radical cystectomy. Upper tract recurrence may be more prone to occur in patients with cancer involvement at the intramural or juxtavesical ureter.
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Kyunggi-do, Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chang
authors.forename: Yong June
authors.initials: YJ
authors.lastname: Kim
authors.forename: Myung Chul
authors.initials: MC
authors.lastname: Gill
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Song
authors.forename: Kwang Taek
authors.initials: KT
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology*; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005629:Frozen Sections; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*