Partial Cystectomy for Transitional Cell Carcinoma of the Bladder

Abstract

Partial cystectomy was performed for urothelium-derived bladder carcinoma in 55 patients in the period 1958-78. Ureteral re-implantation was done in 14 cases. The operative mortality was 7.3%. The five-year and ten-year survival rates were, respectively, 47.1 and 35.4%. The series was subdivided according to grade and T-stage of the tumours. The patients with a grade I or II tumour had significantly better survival rates than those with a grade III or IV tumour. T1 tumours had a more favourable outcome than T2 or T3 tumours, though the difference was not statistically significant. The ten-year prognosis was best when the tumour measured less than 1 cm, but tumour size did not otherwise influence the result. The tumour recurred in 32 (58%) of the patients, in 25 of them within 2 years of operation. The attractions of partial cystectomy include avoidance of urinary diversion and possibility of later, more radical surgery. Prophylactic antibiotic treatment is recommended in order to reduce the operative mortality and morbidity.

Bladder Preservation in Invasive Locally Confined Bladder Cancer

“…The 5-year survival rate in highly selected group of patients varies from 80 to 6% (table 3) [38,39], Local recurrence rate ranges from 30 to 78% [38][39][40][41], The recurrent tumors mainly occur during the first 2 post o p erativ e years [40], Radiotherapy is given pre-or postope rative to prevent tumor seeding within the incisional wound. Based on a literature review, Sweeney et al indicated that about 5-19% of patients undergoing cystectomy would be candidates for partial cystectomy [42], The actual place of partial cystectomy cannot be estimated by the current reports, because all of these publications deal with retrospective analy sis of highly selected patients treated with varying indications over a period of many years.…”

Comparison of the short-term efficacy of sequential treatment with intravesical single-port laparoscopic partial cystectomy with bladder preservation or open partial cystectomy in combination with cisplatin plus gemcitabine chemotherapy

“…In the 1950s, partial cystectomy became widely used to treat muscle-invasive bladder cancer (MIBC); however, due to its high recurrence rate (40-78%), together with the development of controllable urinary diversion technology and the application of total cystectomy with preservation of nerves and prostate, radical cystectomy has become the 'gold standard' for the treatment of MIBC (1)(2)(3). However, study results from a 30-year period indicate that the postoperative 5-year survival rate of radical cystectomy is only 40-60% (4).…”

Partial Cystectomy in the Management of Bladder Carcinoma

“…Partial cystectomy can be combined with radiotherapy and lymph node dissection if results are shown to be improved thereby [8], Over a 25-year period we have continued to use partial cystectomy in selected cases of bladder carcinoma where TUR was considered inade quate or inaccessible [11], The main contraindication for partial cystectomy has been encroachment of the tumor on the bladder neck, multiplicity or evidence of unstable bladder urothelium [4][5][6][9][10][11][12], Ureteric involvement is not a contraindication for this procedure.…”

“…Important criteria include accurate assessment of the tumor with regard to size, multiplicity, depth of penetration, grade of malig nancy and precise site as well as careful evaluation of the rest of the bladder urothelium to detect early cancerous changes [6,[10][11][12]. The evident advantages of reduced operative mortality and morbidity with preservation of bladder function, avoidance of a stoma and preservation of potency make the choice of partial cystectomy, as…”

“…Selection of patients was done after clinical evaluation of the lesion by cystoscopy under gen eral anesthesia. Criterias used in the selection have been published before in the literature [6,11]. In all cases biopsies from the mucosa adjacent to the tumor and remote areas were taken.…”