Radical Cystectomy for Stages TA, TIS and T1 Transitional Cell Carcinoma of the Bladder

Abstract

Between January 1969 and January 1990, 531 patients underwent bilateral pelvic lymph node dissection and radical cystectomy for the management of transitional cell carcinoma of the bladder. Of these procedures 220 were performed for clinical stage Ta (31 patients), Tis (23) or T1 (166) disease, which was either high grade or recalcitrant to transurethral resection and/or intravesical chemotherapy. This subgroup of patients was studied to evaluate the outcome of recurrent or chemotherapy resistant superficial transitional cell carcinoma of the bladder after radical cystectomy. The operative mortality rate for the group was 2.3% and the overall complication rate was 20.4%. The pelvic recurrence rate was 5.9%. The 5-year cancer-specific survival rates for patients with pathological stage Ta (11), Tis (19), T0 (43) and T1 (91) disease were 88%, 100%, 80% and 76%, respectively. The 10-year cancer-specific survival rates were 75%, 92%, 66% and 62%, respectively. A total of 74 patients received preoperative radiation therapy (2,000 rad) but they had no better 5-year cancer-specific survival rates than did nonirradiated patients. Transurethral resection and/or preoperative radiation therapy resulted in a pathological status of T0 in 43 patients but this did not confer a survival advantage. Although bladder preservation is preferable, low operative mortality and pelvic recurrence rates, as well as new methods of continent urinary diversion continue to make radical cystectomy the definitive form of therapy for patients with superficial disease recalcitrant to transurethral therapy.

Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high‐grade, invasive bladder cancer

“…A 3% mortality rate in the present series is comparable with other contemporary series of radical cystectomy [12,15,16]. Furthermore, preoperative therapy (radiation and/or chemotherapy), and the form of urinary diversion used (continent or incontinent) does not apparently alter the mortality rate.…”

“…Even those at highest risk of a local recurrence (lymph nodepositive) had only a 13% local recurrence rate after cystectomy. The use of high-dose, shortcourse preoperative radiation therapy does not appear to reduce the risk of pelvic recurrence [9]; nearly all patients with pelvic recurrence will die from their disease despite additional therapeutic efforts.Clinical staging errors reportedly occur in 30-50% of patients with invasive bladder cancer [15][16][17]. Unlike other therapies, radical cystectomy pathologically stages the primary bladder tumour and regional lymph nodes.…”

The incidence of venous thromboembolism and its effect on survival among patients with primary bladder cancer

“…[6][7][8][9][10][11] The reported perioperative incidence of thrombosis after radical cystectomy ranged from 0.6% to 4.7% for DVT, and from 0.6% to 2.0% for PE. 10,[12][13][14] A similar perioperative incidence of VTE was reported among patients who received prophylactic postoperative anticoagulation therapy. 7,10,11 Patients with bladder cancer who undergo cystectomy tend to share the characteristics of older age, advanced malignancy, prolonged surgery, and general anesthesia, which are known risk factors for VTE.…”

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).…”