Inferior pubic rami resection with en bloc radical excision for invasive proximal urethral carcinoma Academic Article Article uri icon

Overview

MeSH Major

  • Cystadenocarcinoma
  • Prostatic Neoplasms

abstract

  • Carcinoma of the urethra is rare, accounting for less than 1% of all malignancies in men and women. Posterior lesions are more common than anterior lesions and portend a worse prognosis with the best five‐year survival rates approximately 10 and 25% in men and women, respectively. The main cause of failure, with or without preoperative irradiation, is local recurrence. In an effort to improve end results, 12 patients (seven men, five women, with a median age of 58 years) with invasive proximal urethral carcinoma (clinical stage C) have been treated since 1964 at MSKCC. Treatment included preoperative irradiation (2000–6000 rad) followed by surgical excision of the inferior pubic rami with partial (11) or total (1) symphysectomy, anterior perineum, urogenital diaphragm, and genitalia, en bloc with the pelvic organs and lymph nodes. Follow‐up averaged 40 months (range, 1–187 months). Five patients were followed for less than one year (average, 5.4 months). Four have died, one of postoperative complications with no evidence of disease and three of recurrent disease (one local and distant, two distant only). The other patient is clinically free of disease at eight months. Seven patients have been followed for over one year (average, 65 months). Three are alive and well at 14, 91, and 187 months, respectively, with no evidence of disease; one died at 12 months of failure to thrive at home (no autopsy obtained, but presumed metastatic disease); one died at 13 months of local recurrence; one died at 39 months of pulmonary failure without evident carcinoma; and one died at 101 months of a myocardial infarct clinically free of neoplasm. Although there was one postoperative death (8%), two pelvic abscesses requiring surgical drainage (16%), two postoperative intestinal fistulae requiring secondary diversion or repair (16%), and two superior pubic rami fractures (16%), no patient has had pelvic girdle instability, intractable pelvic pain, or prolonged difficulty with gait or sitting. Minor adductor muscle weakness was present in most but did not create a problem in ambulation by the time of hospital discharge. Preoperative irradiation coupled with radical excision and inferior pubic rami resection seems to offer better overall survival (33%), better disease‐free survival (58%: 5/12 died of disease), and better local control (83%) for high‐stage invasive proximal urethral carcinoma than alternative treatment regimens. Copyright © 1983 American Cancer Society

publication date

  • January 1983

Research

keywords

  • Academic Article

Identity

Digital Object Identifier (DOI)

  • 10.1002/1097-0142(19830401)51:7<1238::AID-CNCR2820510711>3.0.CO;2-#

PubMed ID

  • 6825047

Additional Document Info

start page

  • 1238

end page

  • 42

volume

  • 51

number

  • 7