What is the efficacy of radical cystectomy in the treatment of bladder cancer?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The criterion standard for the treatment of patients with stage T2-T4 disease is radical cystoprostatectomy for men and anterior pelvic exenteration for women. Additionally, all patients should undergo bilateral pelvic lymphadenectomy.

Patients who undergo radical cystectomy may benefit from a cancer-specific survival advantage when neoadjuvant chemotherapy is given prior to surgery. The rationale of preoperative chemotherapy includes treatment of micrometastatic disease and pathologic downstaging. However, some patients with node-negative disease are needlessly treated with chemotherapy; in addition, surgery is significantly delayed. A recent meta-analysis of 11 trials showed an overall survival rate benefit of 6.5% among patients who received neoadjuvant chemotherapy. If locally advanced TCC is suspected based on clinical staging, the rationale for neoadjuvant chemotherapy prior to cystectomy is even stronger. [13]

Emerging retrospective data from multiple institutions suggest that an increased interval from the time of the diagnosis to radical cystectomy can adversely affect pathologic stage and survival. For example, at the University of Pennsylvania, patients who underwent radical cystectomy within 12 weeks of the diagnosis had a lower incidence of advanced pathologic stage (42% vs 84% with extravesical disease), lower incidence of positive lymph nodes, and an increased 3-year survival rate (62% vs 35%). [14] Although all studies have been retrospective, sufficient data support the concept of prompt surgical intervention.

Survival data based on pathologic stage and nodal status are detailed in Outcome and Prognosis.


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