The effects of transurethral resection and cystoprostatectomy on dissemination of epithelial cells in the circulation of patients with bladder cancer

This study was undertaken to evaluate the risk of haematogenous disseminati on of epithelial cells induced by endoscopic resection and/or cystoprostate ctomy for transitional cell carcinoma of the bladder. Thirty-three patients were studied. Thirty-one had different stages end grades of bladder cancer and two patients had benign bladder conditions. Twenty-five cancer patient s required transurethral resection of their bladder tumour. Of those, 20 ha d superficial disease (pTaG1-G2: n = 19; pT1G2: n = 1) and five had muscle invasive tumours (pT2G3: n = 2; pT3aG3: n = 1; pT4G3: n = 2). Five patients underwent radical cystoprostatectomy for muscle invasive cancers (pT2G3: n = 3; pT3bG3: n = 1; pT4G3: n = 1) and one man received chemotherapy for me tastatic disease. Venous blood (10 ml) was obtained from the antecubital fo ssa in each patient, before and 1-2 h after completion of surgery, and prio r to treatment in the metastatic patient. An indirect immunocytochemical te chnique was used to detect circulating epithelial cells after centrifugatio n on Ficoll gradient and fixation of mononuclear cells on slides, using a m onoclonal antibody directed against three cytokeratins: CK8, CK18 and CK19. Circulating epithelial cells were detected only in the patient with metast atic disease. None of the other patients had evidence of epithelial circula ting cells before or after surgery. The results suggest that irrespective o f disease stage and grade, neither endoscopic nor open bladder surgery lead s to detectable dissemination of urothelial cells in the peripheral circula tion. These procedures are therefore unlikely to increase the risk of progr ession and metastasis in transitional cell carcinoma of the bladder. (C) 19 99 Cancer Research Campaign.