Login to Access Video or Poster Abstract: MP88-13
Sources of Funding: Roswell Park Alliance Foundation & Friends of Urology

Introduction

Recurrence following radical cystectomy (RC) is a major cause of cancer-specific mortality, and pelvis remains the main site of local recurrence. We sought to investigate whether aggressiveness of bladder cancer correlated with washings in the pelvis & pneumo-peritoneum at different stages of robot-assisted radical cystectomy (RARC).

Methods

20 patients who underwent RARC were prospectively enrolled in the study. 6 samples were collected from each patient: Intra-vesical washing prior to RARC (BW), followed by a series of 3 pelvic irrigations; before RARC (Wash 1), after RARC (Wash 2) and after pelvic lymph node dissection (PLND) (Wash 3). Leftover suction fluid from the whole procedure was also collected (Wash 4). A specialized filter from surgical smoke evacuation device was used to trap any cells circulating in the pneumoperitoneum. Each sample was examined for cytology and the presence of bladder cancer-related markers (CDK1, HOXA13, MDK, IGFBP3). Results were correlated with clinical outcomes.

Results

18 patients were included in the study (2 excluded for concomitant malignancies). MDK had the highest detection rate in the study. CDK1 had the lowest detection rate among the four markers and was only detected in 1 intra-vesical wash (pT1). There was no difference in the detection rate of the mRNA markers between muscle invasive and non-invasive tumors. However, mRNA in the pelvic irrigation and suction fluids were only detected in invasive (78%) and metastatic (100%) stages. Cytology results showed atypical cells in 4 patients (1 - Wash 3, 3 - Wash 4). After a median follow-up of 7 months, 2 patients developed distant recurrences (ypT0/N1, pT4a/N2) and 1 patient had pelvic recurrence (T4b/N0). No transmission of tumor cells was seen in the pneumo-peritoneum insufflation CO2 used during RARC.

Conclusions

This simple novel methodology was able to provide valuable information regarding possible pelvic dissemination. Patients with more advanced disease after RARC may have higher odds of bladder cancer dissemination in the pelvis during RARC.

Funding

Roswell Park Alliance Foundation & Friends of Urology