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Argument against frozen section analysis of distal ureters in transitional cell bladder cancer

Nature Clinical Practice Urology volume 5, pages 538–539 (2008)Cite this article

The risk factors for upper urinary tract recurrence after radical cystectomy in patients with transitional cell bladder cancer are well established, and include a history of diffuse carcinoma in situ, multifocal tumor, prostatic urethral involvement, the presence of intramural tunnel or juxtavesical ureteral involvement with carcinoma in situ, and a prior ureteral tumor.1,2,3,4 Achieving a negative ureteral margin after cystectomy has not, however, been demonstrated to confer a protective benefit against subsequent upper tract recurrence;3,4,5,6,7,8,9 therefore, the practicality and cost-effectiveness of intraoperative ureteral margin frozen section analysis, as a means to achieve a negative ureteral margin, remain a matter of debate.1,2,3

The rationale for obtaining a negative ureteral margin at the time of cystectomy is based on the assumption that a negative margin would translate into better long-term cancer-free survival and prevent future anastomotic or upper urinary tract recurrences. Whether this technique has any beneficial effect on these clinical end points has, however, remained unproven. Furthermore, conservative management of incidental upper tract carcinoma in situ found at the time of cystectomy has been recommended, owing to the high stage-specific mortality in patients undergoing cystectomy, the low morbidity associated with carcinoma in situ of the ureter, and the low overall incidence of subsequent upper tract recurrences.2,3,5,6,10

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References

  1. Culp OS et al. (1967) Experiences with ureteral carcinoma in situ detected during operations for vesical neoplasm. J Urol 97: 679–682

    Article  CAS  Google Scholar 

  2. Sharma TC et al. (1970) Carcinoma in situ of the ureter in patients with bladder carcinoma treated by cystectomy. Cancer 26: 583–587

    Article  CAS  Google Scholar 

  3. Linker DG and Whitmore SF (1975) Ureteral carcinoma in situ. J Urol 113: 777–780

    Article  CAS  Google Scholar 

  4. Johnson DE et al. (1989) Are frozen-section examinations of the ureteral margins required for all patients undergoing radical cystectomy for bladder cancer. Urology 33: 451–454

    Article  CAS  Google Scholar 

  5. Schoenberg MP et al. (1996) Ureteral frozen section analysis during cystectomy: a reassessment. J Urol 155: 1218–1220

    Article  CAS  Google Scholar 

  6. Silver DA et al. (1997) Ureteral carcinoma in situ at radical cystectomy: does the margin matter. J Urol 158: 768–771

    Article  CAS  Google Scholar 

  7. Schumacher MC et al. (2006) Is there an indication for frozen section examination of the ureteral margins during cystectomy for transitional cell carcinoma of the bladder. J Urol 176: 2409–2413

    Article  Google Scholar 

  8. Raj GV et al. (2006) Significance of intraoperative ureteral evaluation at radical cystectomy for urothelial cancer. Cancer 107: 2167–2172

    Article  Google Scholar 

  9. Sang EL et al. (2006) Significance of cancer involvement at the ureteral margin detected on routine frozen section analysis during radical cystectomy. Urol Int 77: 13–17

    Article  Google Scholar 

  10. Kenworthy P et al. (1996) The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter. J Urol 155: 501–503

    Article  CAS  Google Scholar 

  11. Donat SM (2006) Staged based directed surveillance of invasive bladder cancer following radical cystectomy: valuable and effective. World J Urol 24: 557–564

    Article  Google Scholar 

  12. Tran W et al. (2008) Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-ter surveillance. J Urol 179: 96–100

    Article  Google Scholar 

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  1. Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, Kimmel Building, New York, NY 10065, USA donats@mskcc.org

Authors and Affiliations

  1. SM Donat is Associate Attending Surgeon in the Department of Urology at Memorial Sloan–Kettering Cancer Center and Associate Professor of Urology at Weill Cornell Medical College, New York, NY, USA.,

    S Machele Donat

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Donat, S. Argument against frozen section analysis of distal ureters in transitional cell bladder cancer. Nat Rev Urol 5, 538–539 (2008). https://doi.org/10.1038/ncpuro1210

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