Transitional cell carcinoma recurrence impacting intestinal diversion after radical cystectomy. Oncologic outcomes of a rare site of recurrence

Fabio Zattoni, Iliana Bednarova, Alessandro Morlacco, Giovanni Motterle, Paolo Beltrami, Fabrizio Dal Moro, R. Jeffrey Karnes

Research output: Contribution to journalArticlepeer-review


Introduction Transitional cell carcinoma recurrence within an intestinal urinary diversion (TCCUD) after radical cystectomy (RC) is a rare condition with unknown origin, prognosis and treatment. The aim of this study was to describe treatment options and oncologic outcomes of this understudied site of recurrence in a multi-institutional case series. Material and methods TCCUD relapse cases after RC were investigated in a retrospective, multi-insti-tutional study. Surgical approach and adjuvant chemotherapy were discussed. Early and late complications were described according to the Clavien-Dindo classification. Kaplan-Meier method was used to assess progression-free and cancer-specific survival. Results A total of 19 patients were selected. The most common presentation was gross hematuria. The median interval between RC and TCCUD was 51.2 months. Fifteen patients (78.9%) underwent surgical excision, and two underwent concomitant radical nephroureterectomy. In 12 (63.1%) cases the site of TCCUD was the uretero-ileal anastomosis. Tumor invading the muscularis of the intestinal diversion was described in 10 (52.6%) cases. Surgical complications occurred in 7/15 (46.6%) patients, of these two with Clavien-Dindo Grade III. Four patients (21.0%) underwent adjuvant chemotherapy and two (10.5%) both chemotherapy and radiation therapy. During follow up 15 patients (78.9%) presented with other sites of recurrence, with lymph nodes (21.0%) and liver (15.7%) being the most common localiza-tions. Recurrence free and overall survival rates were 36.8% and 15.8%, and 56.5% and 24.2%, respectively at 12 and 18 months. Conclusions Most patients with TCCUD have invasive disease and a substantial percentage experience upper tract cancer during their disease course. TCCUD is often the herald of advanced disease and systemic progression, with poor progression-free and overall survival rates.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalCentral European Journal of Urology
Issue number4
StatePublished - 2020


  • Bladder cancer
  • Radical cystectomy
  • Recurrence
  • Transitional cell carcinoma
  • Undiversion
  • Urinary diversion
  • Urinary diversion/adverse effects

ASJC Scopus subject areas

  • Urology


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