"Is partial cystectomy an oncologically viable option for primary urachal adenocarcinoma?"

Abstract

Aim: Urachal adenocarcinomas (UA) of the urinary bladder constitute 2% of all urinary bladder malignancies and arise at the dome of the bladder. Most UA are treated with a partial cystectomy (PC) with en bloc resection of the median umbilical ligament and umbilicus. We aim to evaluate the oncological outcome of patients treated for UA using partial cystectomy in our department.

Patients and methods: Twelve were diagnosed with UA on initial transurthral resection (TUR) biopsies from January 2001 until October 2010. The mean age at the time of diagnosis was 57.67 years (Range 37-82) amongst whom 67% (8) were male. Two patients had previous malignancies which included TCC of the ureter and Prostate Adnenocarinoma. The mean duration from diagnosis to PC was 5.6 weeks (Range 3-11). Fifty percent (6) of patients underwent a cystogram and the all catheters were removed at 2 weeks following PC. Histology in all 12 patients confirmed UA and the incidence of serosal positive margin rate was 33% (4). All patients were followed up with sequential cystoscopies and radiological imaging.

Results: At a mean follow up of 36.9 months (4.4-97.2), the incidence of local recurrence was 8.3% (1) and this patient had a subsequent radical cystectomy. Distant metastasis was seen in 33% (4) of patients amongst whom 2 had positive margins with no evidence of prior local recurrence. Four patients (33%) died of UA and all cases with metastatic disease belonged to stage pT3 or higher.

Conclusion: Partial cystectomy is an oncologically viable option in patients with Urachal adenocarcinomas. The final stage and serosal positive margin status on the final histopathological analysis of the specimen at partial cystectomy are significant predictive factors on the risk of metastasis and local recurrence. Patients with both the above factors should be followed up very closely to identify local recurrence and metastasis.