Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction

Abstract

Background. Many patients with aggressive clinically superficial bladder cancer ultimately die of their cancer, due in part to resistance to undergo radical cystectomy. Radical cystectomy is usually curative for patients with pathologic superficial tumors. Orthotopic urinary reconstruction has lessened the morbidity and life‐style changes in patients after cystectomy, and may increase patient acceptance of cystectomy as therapy for high risk superficial tumors. Methods. A retrospective analysis was performed on 182 patients with clinically superficial bladder cancer (Ta, Tis, T1) who had radical cystectomy between 1971 and 1989, to determine the incidence of pathologic upstaging and to assess overall survival, cause‐specific survival, and recurrence free survival. Indications for cystectomy included failure of intravesical chemo‐ or immunotherapy, high grade lamina propria invasive tumors, presence of bladder diverticulae, spread of superficial tumors into the prostatic urethra, and endoscopically uncontrollable tumors. Results. Pathologic upstaging to muscle‐invasive or metastatic tumors occurred in 34% of patients, and of these, only half remained organ confined. Metastases were present in 8% of patients at the time of cystectomy. Mucosa‐confined tumors were upstaged only 19% of the time, whereas tumors demonstrating lamina propria invasion (T1) were upstaged 40% of the time. Pathologic upstaging to muscle‐invasive or metastatic disease was significantly associated with a decreased probability of survival (P = 0.042). With a median follow‐up of 7.2 years, overall survival was estimated to be 86%, 72%, and 47%, and recurrence free survival 90%, 83%, and 77% at 2, 5, and 10 years, respectively. Conclusions. Pathologic upstaging to muscle‐invasive or metastatic tumors occurs in one third of highly selected patients with clinically superficial bladder cancer who have had radical cystectomy, half of whom have extravesical disease. Survival is significantly decreased in this group of upstaged patients. With the alternative of orthotopic urinary diversion available to most men and women requiring cystectomy, radical cystectomy should be considered a viable alternative to continued conservative measures for selected patients with aggressive superficial bladder tum.

Laparoscopic radical cystectomy and urinary diversion: fad or future?

“…From previous reports the shortest mean hospital stay after open surgery is 8.5-11 days, although undoubtedly it is even longer in many units [23,24]. In the laparoscopy series the time to oral intake is typically 2-4 days, with discharge home at 6-8 days.…”

Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort

“…Increasingly, clinicians routinely perform a restaging TUR for patients with HGT1 bladder cancer followed by induction and maintenance BCG (1). High incidences of clinical understaging (34 -64%) have been cited to support this recommendation (11,(19)(20)(21)(22). Restaging TUR and identification of patients with clinical T2 disease that should be treated with RC shows a substantial advantage for recurrence and progression free survival (23).…”

Profile of gallbladder diseases diagnosed at afyon kocatepe university: a retrospective study

“…our results are consistent with those reported in the literature and indicate that it may be associated with aggressive tumor behavior in urothelial carcinomas. The 5-year survival among high-risk superficial urothelial carcinomas that undergo early cystectomy is about 90% (23,24). However, the quality of life decreases markedly in patients who undergo cystectomy and the patients can also die because of cystectomy-related complications (2,25,26).…”