At 3 months after radical cystectomy:
- Oncologic – there is no role for oncologic surveillance this early after radical cystectomy according to Dr. Veskimae.
- Non-oncologic – urinary tract obstruction, pyelonephritis, intestinal obstruction, and metabolic acidosis.
- Oncologic – patients are at risk for early local recurrence, with a probability of 4-24%at 6-36 months. Risk factors include T4 stage, soft tissue surgical margins, and variant histology. Treatment options include adjuvant radiotherapy, chemotherapy or surgical resection.
- Non-oncologic – patients are at risk of ureteroenteric stricture and neurogenic bladder and should be taught clean intermittent catheterization (in the setting of a neobladder).
- Oncologic – patients are at risk of local and distant recurrence, as well as a urethral tumor.
- Non-oncologic – patients remain at risk of ureteroenteric stricture with an incidence of 2-10%. These are mostly asymptomatic instances and risk factors may involve surgical technique, such as devascularization of the ureter during dissection. Tumor recurrence should be ruled out and subsequently the optimal treatment is operative reconstruction. Patients are also at risk of parastomal hernias at this point in follow-up, occurring in 27-50% of individuals. Risk factors include surgical technique, age, diabetes, smoking, COPD, and obesity. Up to 30% of these patients will undergo surgical repair.
- Oncologic – patients remain at risk of local and distant recurrence, which occurs in up to 50% of patients. More than half of these patients are diagnosed based on symptoms. Secondary urethral recurrence may also recur at this point in time with an incidence of 0.8-6.1% and risk factors including pT-stage, multi-focality, prostatic urethral/bladder neck involvement
- Non-oncologic – patients remain at risk for parastomal hernia and neurogenic bladder requiring catheterization
- Oncologic – patients remain at risk of local, urethral, and distant recurrence, as well as upper tract recurrence. The incidence of upper tract recurrence at this point in time is 1.8-6%, and 60% are asymptomatic. Risk factors include NMIBC, multi-focality, and positive ureteral margins. Patients should be investigated with CT imaging and cytology. Patients may also be at risk of malignant ureter-enteric strictures, which includes 16% of all strictures. These occur later than benign strictures and risk factors include CIS at the ureteral margin.
- Oncologic – 12% of all recurrences occur late, however have better OS than early recurrences. The risk factors for late recurrence include younger age and non-organ confined disease.
- Non-oncologic – by this time period, 45% of patients have had non-oncologic complications.
Presented by: Erik Veskimae, Tampere University Hospital, Tampere, Finland
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark