When is partial cystectomy indicated in the treatment of urothelial carcinoma?

Updated: Apr 03, 2019
  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Urothelial carcinoma (also called transitional cell carcinoma) accounts for the vast majority of bladder cancer in the United States. However, in some countries, squamous cell carcinoma is the dominant subtype of bladder cancer because of chronic infection with Schistosomiasis hematobium.

Partial cystectomy for urothelial carcinoma is recommended in properly selected cases. Suggested selection criteria include the following:

  • No history of multifocal bladder cancer (negative random bladder biopsies)

  • No evidence of metastatic disease

  • Absence of multiple lesions (including carcinoma in situ)

  • Solitary, high grade muscle-invasive tumor located in a position that is amenable to wide resection (ideally achieving 1-2 cm margins)

  • Tumor located away from the ureteral orifices (although resection and re-implantation is possible, but associated with poorer prognosis) and not involving bladder neck or prostate

  • Expectation that the residual postoperative bladder will have adequate capacity and compliance to ensure functionality

As a result of such strict criteria, relatively few patients with muscle invasive bladder cancer are candidates for bladder-sparing surgery. [7] The most common lesions amenable to partial cystectomy are high-grade tumors located in the lateral walls or dome of the bladder.


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