Moderated Poster Session V: Oncology/Laparoscopy/Robotics/Basic Science

摘要

Background: Local recurrence remains a major cause of cancer-specificmortality following radical cystectomy. We sought to investigate tumordissemination in the operative field and contribution of pneumoperitoneumduring robot-assisted radical cystectomy (RARC).Methods: Six RARCs were included. Four pelvic irrigations with 0.9%normal saline were performed: Sample I: before RARC; Sample II: afterRARC; Sample III: after pelvic lymph node dissection (PLND), and leftoverirrigation fluid at end of procedure (Sample IV). CO2 used for pneumoperitoneumwas filtered using surgical smoke plume evacuation device. Filterwas then removed, washed with 0.9% saline, centrifuged and sedimentwas analyzed. Intravesical bladder irrigations were performed for threepatients. Methodology: pelvic irrigations (SI-IV) were examined for cytologyusing thin preparation and cell block by a genito-urinary pathologist/cytopathologist. Meanwhile, intravesical wash, pelvic irrigation, and filtersediment were analyzed for mRNA expression of bladder cancer relatedgenes. mRNA expression was examined by qRT-PCR, with human bladdercancer cell line 253J and GAPDH (controls). Epithelial cell markers EpCAM,cytokeratins 8, 18, and 19 were also assessed. Bladder cancer gene panelsused in the Cxbladder Detect urinary test were also examined (CDK1, MDK,IGFBP5, HOXA13 and CXCR2).Results: Four patients received neoadjuvant chemotherapy. The meanoperative time was 300 minutes. Four patients had pT1 disease, two hadpT2 disease. All patients had negative soft tissue surgical margins andmean LNY was 31. One patient had positive lymph nodes. No spillageof tumor cells or inadvertent entry into the bladder was observed. Alllymph nodes were removed in specimen bags. Cytology: Pelvic Irrigationshowed mostly blood, inflammatory, mesothelial cells and macrophages.All specimens were negative for malignant cells. mRNA expression: Bladdercancer-related mRNA was detected in the intra-vesical wash and 253Jbladder cancer cells (control). In contrast, all pelvic irrigations and filtersediment had very low or undetectable mRNA levels. However, in patientwith node positive disease, SI irrigation showed many epithelial markers(KRT8, 18, 19, IGFBP5).Conclusions: Our preliminary analysis showed that bladder cancer cells,bladder cancer-related genes and epithelial markers were not present inpelvic irrigation but in intravesical wash. These cells were detected in thepelvis in one patient with advanced disease. Active enrollment in this studycontinues, which will allow better understanding of local spread of bladdercancer. Funding by Roswell Park Alliance Foundation.