MIBC Flashcards
imaging
nodal size
CT and MRI show similar results in the detection of lymph node metastases in a variety of primary pelvic tumours.
Pelvic nodes > 8 mm and abdominal nodes > 10 mm in maximum short-axis diameter, detected by CT or MRI, should be regarded as pathologically enlarged.
css if progress from nmic to mibc
CSS after progression from NMIBC to MIBC was 35%, which is significantly worse compared to patients with MIBC without a history of NMIBC
nordic trials
Nordic I, Nordic II, and BA06 30894 trials showed an 8% absolute improvement in survival at five years with a number needed-to-treat of 12.5.
arguments against NAC
- Delayed cystectomy might compromise the outcome in patients not sensitive to chemotherapy, although published studies on the negative effect of delayed cystectomy only include chemonaive patients. There are no trials indicating that delayed surgery, due to NAC, has a negative impact on survival.
- Neoadjuvant chemotherapy does not seem to affect the outcome of surgical morbidity. In one randomised trial the same distribution of grade 3-4 post-operative complications was seen in both treatment arms.
lymphadenectomy
standard
extended
super extended
Standard lymphadenectomy in BC patients involves removal of nodal tissue cranially up to the common iliac bifurcation, with the ureter being the medial border, and including the internal iliac, presacral, obturator fossa and external iliac nodes.
Extended lymphadenectomy includes all LNs in the region of the aortic bifurcation, and presacral and common iliac vessels medial to the crossing ureters. The lateral borders are the genitofemoral nerves, caudally the circumflex iliac vein, the lacunar ligament and the LN of Cloquet, as well as the area described for standard Lymphadenectomy.
Super-extended lymphadenectomy extends cranially to the level of the inferior mesenteric artery
how many LN remove
Removal of at least ten LNs has been postulated as sufficient for evaluation of LN status, as well as being beneficial for OS in retrospective studies the available evidence indicates that any kind of LND is advantageous over no LND.
Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits
CI to complex diversion
Contraindications to more complex forms of urinary diversion include:
• debilitating neurological and psychiatric illnesses;
• limited life expectancy;
• impaired liver or renal function;
• transitional cell carcinoma of the urethral margin or other surgical margins.
CI to neobladder
Relative contraindications specific for an orthotopic neobladder are
high-dose pre-operative RT,
complex urethral stricture disease,
and severe urethral sphincter-related incontinence
rate of stomal complication and uut complications
The main complications in long-term follow-up studies are stomal complications in up to 24% of cases and functional and/or morphological changes of the UUT in up to 30%
neobladder continence rate
93%
day and nighttime
periop mortality
the peri-operative mortality was reported as 1.2-3.2% at 30 days and 2.3-8.0% at 90 days
action denosumab
Denosumab is a fully human monoclonal antibody that binds to and neutralises RANKL (receptor activator of nuclear factor-KB ligand), thereby inhibiting osteoclast function and preventing generalised bone resorption and local bone destruction.
dose of RT
66Gy over 6 weeks
target field bladder only
not sensitivie to EBRT
CIS
adno
SCC
role of NC in EBRT
should be offered
