Urachal carcinoma in the practice of a surgical oncologist: a clinical case series
Summary. Actuality. Urachal carcinoma (UC) is a neoplasm that is rarely encountered in the practice of oncologists, oncological surgeons, and urologists. Although the clinical manifestations of the disease are identical to bladder cancer, the approaches to treatment differ significantly. The purpose of the work. To present a series of clinical cases, demonstrate the therapeutic measures applied, and evaluate their effectiveness. Materials and methods. A clinical case series of UC was reviewed, variants of the clinical presentation of the disease, applied diagnostic methods, and approaches to multimodal treatment were evaluated. Results. In all patients, the disease was diagnosed at the locally advanced (III) or metastatic (IV) stages after the onset of macrohematuria. Patients with locally advanced disease underwent combined treatment with the use of a surgery (en bloc resection of urachal remnant with partial cystectomy and bilateral pelvic lymphadenectomy) and adjuvant radiotherapy. These patients are under observation for 17 and 14 months without signs of recurrence. The follow-up program after radical treatment included cystoscopy and computed tomography. A case of stage IV metastatic adenocarcinoma of the urachus with metastatic lung lesions is also demonstrated. A multimodal approach to the treatment of advanced UC with neoadjuvant courses of polychemotherapy, cytoreductive surgery, metastasectomy with subsequent chemotherapy allowed achieving remission of the disease. Conclusions. Analysis of the demonstrated cases of UC highlights the difficulties in diagnosing UC at early stages. For patients with localized UС, surgical treatment consisting of en bloc resection of urachal remnant with partial cystectomy and bilateral pelvic lymphadenectomy and adjuvant radiotherapy allows achieving acceptable oncological results and maintaining a satisfactory quality of life. The effectiveness of the treatment of the metastatic UC and achieving remission of the disease depends on the feasibility of removing the primary tumor, its metastases and the use of systemic chemotherapeutic treatment. Modern treatment approaches allow achieving acceptable results, but more observations are needed to assess long-term consequences. Significant differences between UС and bladder cancer dictate the creation of an independent staging system for UС.
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