World Journal of Urology

, Volume 24, Issue 5, pp 509–516 | Cite as

Improving outcomes with radical cystectomy for high-grade invasive bladder cancer

Topic Paper


It is clear that the optimal clinical outcomes in bladder cancer patients requiring radical cystectomy are related to standard histopathologic variables of tumor grade, stage and lymph node status. However, other less well defined variables are also critical to the successful outcomes of these patients. Patients with muscle invasive bladder cancer and treating physicians should avoid unnecessary and significant treatment delays. In addition, hospital and surgeon-volume/experience are thought to be factors that may too be important components that relate to the clinical outcomes of patients following surgery. Lastly, there is a growing body of literature to support the concept of an appropriate lymphadenectomy at the time of surgery, for both node-positive and node-negative bladder cancer patients. It is becoming more obvious that there are multiple variables involved in the clinical success and outcomes of patients with bladder cancer following radical cystectomy. As treating physicians and surgeons we must be aware of these components to ensure the best outcomes for our patients.


Transitional cell carcinoma Surgical delay Surgical volume Hospital volume Lymphadenectomy Lymph node metastases 


  1. 1.
    Jamal A, Taylor M, Ward E et al (2005) Cancer statistics 2005. CA Cancer J Clin 55:10–20CrossRefGoogle Scholar
  2. 2.
    Prout G, Marshall VF (1956) The prognosis with untreated bladder tumors. Cancer 9:551–558PubMedCrossRefGoogle Scholar
  3. 3.
    Sanchez-Ortiz RF, Huang W, Mick R, Van Arsdalen KN, Wein AJ, Malkowicz SB (2003) An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol 169:110–115PubMedCrossRefGoogle Scholar
  4. 4.
    Lee CT, Madii R, Daignault S, Dunn RL, Zhang Y, Montie JE, Wood DP Jr. (2006) Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol 175:1262–1267PubMedCrossRefGoogle Scholar
  5. 5.
    Hautmann RE, Paiss T (1998) Does the option of the ileal neobladder stimulate patient and physician decision toward earlier cystectomy? J Urol 159:1845–1850PubMedCrossRefGoogle Scholar
  6. 6.
    Chang SS, Hassan M, Cookson MS, Wells N, Smith JA Jr (2003) Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol 170:1085–1087PubMedCrossRefGoogle Scholar
  7. 7.
    Muhmud SM, Fong B, Fahmy N, Tanguay S, Aprikian AG (2006) Effect of preoperative delay on survival in patients with bladder cancer undergoing cystectomy in Quebec: a population based study. J Urol 175:78–83CrossRefGoogle Scholar
  8. 8.
    Liedberg F, Anderson H, Mansson W (2005) Treatment delay and prognosis in invasive bladder cancer. J Urol 174:1777–1781PubMedCrossRefGoogle Scholar
  9. 9.
    Wiesner C, pfitzenmaier J, Faldum A, Gillitzer R, Melchior SW, Thuroff JW (2005) Lymph node metastases in non-muscle invasive bladder cancer are correlated with the number of transurethral resections and tumour upstaging at radical cystectomy. BJU Int 95:301–305PubMedCrossRefGoogle Scholar
  10. 10.
    May M, Nitzke T, Helke C, Vogler H, Hoschke B (2004) Significance of the time period between diagnosis of muscle invasion and radical cystectomy with regard to the prognosis of transitional cell carcinoma of the urothelium in the bladder. Scand J Urol Nephrol 38:231–235PubMedCrossRefGoogle Scholar
  11. 11.
    Herr HW (2005) Surgical factors in the treatment of superficial and invasive bladder cancer. Urol Clin North Am 32:157–164PubMedCrossRefGoogle Scholar
  12. 12.
    Lange PH, Lin DW (2004) Does the who and how of surgery in bladder cancer matter. J Clin Oncol 22:2762PubMedCrossRefGoogle Scholar
  13. 13.
    Stein JP, Lieskovsky G, Cote R, Groshen S, Feng A-C, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1054 patients. J Clin Oncol 19:666–675PubMedGoogle Scholar
  14. 14.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137PubMedCrossRefGoogle Scholar
  15. 15.
    Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJO, Stukel TA (2006) Volume and process of care in high-risk cancer surgery. Cancer 106:2476–2481PubMedCrossRefGoogle Scholar
  16. 16.
    Begg CB, Reidel ER, Bach PB et al (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346:1138–1144PubMedCrossRefGoogle Scholar
  17. 17.
    Dimick J, Pronovost P, Cowan JA, Lipsett P, Stanley J, Upchurch GJ (2003) Variation in postoperative complication rates after high-risk surgery in the United States. Surgery 134:534–540PubMedCrossRefGoogle Scholar
  18. 18.
    Elting LS, Pettaway C, Bekele BN, Grossman BH, Cooksley C, Avritscher EBC, Dinney CP (2005) Correlation between annual volume of cystectomy, professional staffing and outcomes. Cancer 104:975–984PubMedCrossRefGoogle Scholar
  19. 19.
    Konty BR, Allareddy V, Modak S, Smith B (2006) Mortality after major surgery for urologic cancers in specialized urologic hospital: are they any better? J Clin Oncol 24:2006–2012CrossRefGoogle Scholar
  20. 20.
    Birkmeyer J, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127PubMedCrossRefGoogle Scholar
  21. 21.
    Herr H, Lee C, Chang S, Lerner S (2004a) For the Bladder Cancer Collaborative Group: Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer; a collaborative group report. J Urol 171:1823–1828CrossRefGoogle Scholar
  22. 22.
    McCabe JE, Jibawi A, Javle P (2005) Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy. BJU Int 96:806–810PubMedCrossRefGoogle Scholar
  23. 23.
    National Institute of Clinical Excellence(2003) Draft, Urologic Cancer Standards: manual of cancer services standards. National Institute of Clinical Excellence, LondonGoogle Scholar
  24. 24.
    Herr HW, Faulkner JR, Grossman HB, Natale RB, White RD, Sarosdy MF, Crawford ED (2004) Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol 22:2781–2789PubMedCrossRefGoogle Scholar
  25. 25.
    Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349:859–866PubMedCrossRefGoogle Scholar
  26. 26.
    Barth PJ, Gerharz EW, Ramaswamy A et al (1999) The influence of lymph node counts on the detection of pelvic lymph node metastasis in prostate cancer. Pathol Res Pract 195:633–636PubMedGoogle Scholar
  27. 27.
    Terrone C, Guercio S, DeLuca S, Poggio M, Castelli E, Scoffone C, Tarabuzzi R, Scarpa RM, Fontana D, Rossetti SR (2003) The number of lymph nodes examined and staging accuracy in renal cell carcinoma. BJU Int 91:37–40PubMedCrossRefGoogle Scholar
  28. 28.
    Stein JP, Quek ML, Skinner DG (2006) Lymphadenectomy for invasive bladder cancer: I. Historical perspective and contemporary rationale. BJU Int 97:227–231PubMedCrossRefGoogle Scholar
  29. 29.
    Stein JP, Quek ML, Skinner DG (2006) Lymphadenectomy for invasive bladder cancer. II. Technical aspects and prognostic factors. BJU Int 97:232–237PubMedCrossRefGoogle Scholar
  30. 30.
    Stein JP (2003) Indications for early cystectomy. Urology 62:591–595PubMedCrossRefGoogle Scholar
  31. 31.
    Leissner J, Ghoneim MA, Abol-Enein H, Thuroff JW, Franzaring L, Fisch M, Schulze H et al (2004) Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol 171:139–144PubMedCrossRefGoogle Scholar
  32. 32.
    Poulsen AL, Horn T, Steven K (1998) Radical cystectomy; extending limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall. J Urol 160:2015–2020PubMedCrossRefGoogle Scholar
  33. 33.
    Vieweg J, Gschwend JE, Herr HW, Fair WR (1999) The impact of primary stage on survival in patients with lymph node positive bladder cancer. J Urol 161:72–76PubMedCrossRefGoogle Scholar
  34. 34.
    Leissner J, Hohenfellner R, Thuroff JW, Wolf HK (2000) Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis. BJU Int 85:817–823PubMedCrossRefGoogle Scholar
  35. 35.
    Vazina A, Dugi D, Shariat SF, Evans J, Link R, Lerner SP (2004) Stage specific lymph node metastasis mapping in radical cystectomy specimens. J Urol 171:1830–1834PubMedCrossRefGoogle Scholar
  36. 36.
    Abdel-Latif M, Abol-Enein H, El-Baz M, Ghoneim MA (2004) Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis. J Urol 172:85–89PubMedCrossRefGoogle Scholar
  37. 37.
    Smith JA, Whitmore WF Jr (1981) Regional lymph node metastasis from bladder cancer. J Urol 126:591–593PubMedGoogle Scholar
  38. 38.
    Bochner BH, Cho C, Herr HW, Donat M, Kattan MW, Dalbagni G (2004) Prospective packaged lymph node dissections with radical cystectomy: evaluation of node count variability and node mapping. J Urol 172:1286–1290PubMedCrossRefGoogle Scholar
  39. 39.
    Brossner C, Pycha A, Toth A, Mian C, Kuber W (2004) Does extended lymphadenectomy increase the morbidity of radical cystectomy? BJU Int 93:64–66PubMedCrossRefGoogle Scholar
  40. 40.
    Herr HW, Bochner BH, Dalbagni G, Donat SM, Reuter VE, Bajorin DF (2002) Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. J Urol 167:1295–1298PubMedCrossRefGoogle Scholar
  41. 41.
    Konety BR, Joslyn SA, O’Donnell MA (2003) Extent of pelvic lymphadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the surveillance, epidemiology and end results program data base. J Urol 169:945–950CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Urology, Norris Comprehensive Cancer Center, MS #74University of Southern California Keck School of MedicineLos AngelesUSA

Personalised recommendations