Surgical Management of Bladder Carcinoma

Rafael Carrion, MD, John Seigne, MB

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Appearance Suggesting an Invasive Tumor (T1 or Greater)

When the suspected diagnosis is invasive bladder cancer (based on the appearance of the tumor), it is reasonable to perform a more limited resection to obtain sufficient tissue, including deep muscle, in order to establish a diagnosis since the majority of these patients will go on to have a radical cystectomy. However, in most cases, we attempt to completely resect the tumor for two reasons. First, a tumor that appears to be invasive may in fact be a superficial T1 tumor, and second, an aggressive TUR to remove as much visible tumor as possible is an important component of any bladder-sparing approach,[7,8] which may be a therapeutic option for the patient. Following gross resection of the tumor, we perform biopsies of the tumor bed and submit these separately for pathologic assessment of the completeness of the resection. In the past, we routinely performed prostatic urethral biopsies since urethral involvement indicates an increased risk of local recurrence, suggesting the need for urethrectomy at the time of cystectomy.[9] Recent data suggest that urethral recurrence is not a problem if continent urinary diversion to the urethra is performed and a frozen section margin from the tip of the prostate is negative.

Following completion of the tumor resection, a careful bimanual examination is needed to assess for any residual mass and to determine if the bladder and tumor mass are mobile or fixed to the pelvic sidewall. Patients in whom the mass is fixed to the sidewall (cT4b) are at increased likelihood to be inoperable or have positive margins at the time of surgery. This patient subgroup may benefit from preoperative chemotherapy.[10,11]

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