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

Abstract

improved the quality of life of patients requiring bladder removal, eliminating the need for urostomy appliances, cutaneous stomas and the need for catheterization in most instances [5]. For these reasons radical cystectomy has become a standard therapy for high-grade, invasive bladder cancer.The purpose of this report is to update a previous review of our institutional clinical experience with high-grade, invasive bladder cancer in a large group of patients treated uniformly with radical cystectomy and extended bilateral pelvic lymphadenectomy over a 25-year period, with a long-term follow-up [3]. These outcome data provide prognostic information for physicians treating patients with bladder cancer, and set a standard to which other therapies can be compared. PATIENTS AND METHODSFrom 1971 to 1997, 1054 patients (843 men, 80%, and 211 women; median age 66years, range 22-93) underwent radical cystectomy for primary TCC of the bladder with the intent to cure. The results from these patients were reported previously [3]. The indication for cystectomy was based on cystoscopic and biopsy findings including: tumour invasion of the muscularis propria or prostatic stroma; high-grade, invasive tumours associated with carcinoma in situ (CIS); CIS refractory to intravesical chemotherapy or immunotherapy; recurrent multifocal superficial disease refractory to repeat transurethral resection with/without intravesical therapy; and tumours involving a bladder diverticulum. Overall, 94% of patients had high-grade bladder tumours.All patients underwent a previously described, standard surgical procedure including a meticulous bilateral pelvic iliac lymphadenectomy with en bloc radical cystectomy, and urinary diversion [6]. The specific form of urinary diversion, either incontinent (conduit) or continent (cutaneous or orthotopic), relates primarily to the particular era in which the urinary system was reconstructed (Table 1). A conduit form of diversion was replaced by a continent cutaneous form of reconstruction in 1982, with orthotopic reconstruction ultimately becoming the primary form of urinary diversion in 1986 for men [7], and in 1992 for women [8] at our institution.The use of adjuvant therapies (radiation and/or chemotherapy) developed over the 25years of treating patients for bladder cancer. From 1971 to 1978, 97 patients received a high-dose short course of radiation therapy ( ª 1600rads) delivered over 4days immediately before cystectomy; these patients were compared with 248 of similar pathological stage who underwent cystectomy between 1979 and 1986, and who received no adjuvant radiation or systemic chemotherapy [9]. There was no significant difference in time to recurrence or overall survival between the groups. Furthermore, there was no difference in the incidence of pelvic recurrence.From 1978 to the present, systemic chemotherapy was selectively given to 272 patients (26%), i.e. 211 in an adjuvant setting after surgery, based on pathological analysis of the primary bladder tumour and regional lymph nodes, and 48...

The prognostic impact of pelvic lymph node metastasis and lymphovascular invasion on bladder cancer

“…13 This observation was confirmed by single-center reports with median lymph node counts ranging from 8 to 30. [14][15][16][17] To date, there is no consensus as to how many lymph nodes for which group of patients should be removed to optimize outcomes after RC. 18 Our results suggest that only patients with organ-confined tumor stages and positive lymph nodes can benefit from pelvic lymph node dissection with curative intent, whereas no advantage can be postulated for patients with ՆpT3.…”

Sexual dysfunction after pelvic surgery

“…Sexual dysfunction after RC RC has been the standard treatment for aggressive superficial bladder cancer and invasive carcinoma, 25 which consists of removal of the bladder, prostate, seminal vesicles and vas in males, bladder, urethra, anterior vaginal wall, uterus and ovaries in females. The treatments used to manage genitourinary cancers have been commonly associated with sexual dysfunction.…”

Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid‐term oncological outcome

“…1,2 However, significant morbidity is associated with conventional radical cystectomy in 20-50% of patients. 3,4 The recent worldwide acceptance of minimally invasive treatments such as laparoscopic surgery could provide options to reduce the morbidity after conventional surgery.…”