Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease.
OBJECTIVE
To assess the clinical outcome of patients with bladder cancer who underwent attempted radical cystectomy (RC) with curative intent, but whose procedures were aborted due to intraoperative findings of metastatic disease, as the presence of metastatic disease at RC is associated with a poor prognosis and there are no data on the optimum management strategy in this situation.


METHODS
In all, 248 consecutive patients with bladder cancer had attempted RC at one academic institution between 1994 and 2003. We retrospectively reviewed the records of 35 patients who had an aborted RC due to intraoperative findings of metastatic disease. The pathological characteristics, time to recurrence, overall survival, disease-specific survival, and suitability for adjuvant or salvage therapies were examined.


RESULTS
Of the 35 patients who had an aborted RC for metastatic disease, 21 (60%) died from the disease within the study period (median time to cancer-specific death 26.4 months), 11 (31%) are alive with evidence of persistent disease or progression, and three (9%) are alive with no evidence of recurrence or progression. Seven patients had a salvage RC after successful adjuvant treatment, of whom three died from recurrent disease (at a mean of 46.5 months after initial exploration, 31.9 months after salvage RC), one is alive with bladder cancer recurrence to the rectum 10 months after salvage cystectomy, and three have no evidence of disease progression at a mean of 10 months after salvage RC.


CONCLUSIONS
The prognosis of patients who undergo an aborted attempt at curative RC due to intraoperative findings of metastatic disease is poor. Although a few patients might subsequently have salvage RC, many of these patients still have poor outcomes even if adjuvant treatments are used. When metastatic disease is discovered at RC, completing the cystectomy should be considered, although further studies are needed to show a clinical benefit.
Guzzo
Thomas J
TJ
The Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-2101, USA.
Rogers
Craig G
CG
Deng
Chris Y
CY
Bivalacqua
Trinity J
TJ
Palapattu
Ganesh S
GS
Bastian
Patrick J
PJ
Eisenberger
Mario A
MA
Schoenberg
Mark P
MP
Gonzalgo
Mark L
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*