Surgical Management of Bladder Carcinoma

Rafael Carrion, MD, John Seigne, MB

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Abstract and Introduction

Abstract

Background: Despite advances in medical oncology, radiation therapy, and molecular and cell biology, the mainstay in the management of bladder cancer continues to be surgery.
Methods: The authors reviewed the literature regarding the endoscopic diagnosis and management of bladder cancer as well the role of partial and radical cystectomy.
Results: Cystoscopy and transurethral resection are required to diagnose and stage bladder cancer. The indications for random bladder biopsies, prostatic urethral biopsy, and re-resection of the tumor bed are examined. The results and complications of endoscopic resection in the management of Ta, T1, and T2 or greater bladder cancer are reported. The roles of partial cystectomy, radical cystectomy, extent of lymphadenectomy, and indications for urethrectomy are also examined. The results and complications of radical cystectomy for the management of T2, T3, T4, and N+ bladder cancer are reported.
Conclusions: Surgery remains a critical element in the management of bladder cancer. Improvements in surgical technique, urinary reconstruction, and multimodal therapy continue to improve the prognosis and quality of life of patients with transitional cell cancer of the bladder.

Introduction

Despite advances in medical oncology, radiation therapy, and molecular and cell biology, surgery continues to be the mainstay of the management of bladder cancer. The initial assessment, diagnosis, and staging of bladder cancer are determined with cystoscopy. Therapy of the more common superficial bladder cancer is by cystoscopic transurethral resection (TUR), with intravesical cytotoxic chemotherapy and immunotherapy being used almost exclusively in an adjuvant setting. Surgery continues to be an important part of the management of invasive bladder cancer, used either in the more classical approach (ie, radical cystectomy and urinary diversion) or as a component of a combined-modality bladder-sparing approach (ie, aggressive TUR with radiation and chemotherapy). This review focuses on the critical principles and controversies in both the endoscopic and open surgical approaches to superficial and invasive bladder cancer.

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