Abstract
Treatment of T4 bladder cancer patients remains a clinical challenge. Conservative management is often insufficient regarding local control, neoadjuvant chemotherapy delays definite treatment while leading to increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has also been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome, including therapy-related complications, in 20 T4 bladder cancer patients subjected to primary cystectomy. Twenty patients underwent radical cystectomy for T4 bladder cancer. At the time of surgery, 8 patients had regional lymph node metastases. The median postoperative follow-up was 13 months for the whole group. Mean duration of postoperative hospitalization was 19 days. Ten patients received no intra- or postoperative blood transfusions, whereas an average number of 3 blood units were administered in the remaining cases. Major therapy-associated complications were paresthesia affecting the lower extremities (n = 3) as well as insignificant pulmonary embolism, enterocutaneous fistulation and acute renal failure in one patient, respectively. At the time of data evaluation, 11 patients were still alive after a follow-up of 20 months. Four patients ≥70 years at the time of cystectomy were still alive after 11, 22 and 31 months following surgery, respectively. The current data demonstrate primary cystectomy for T4 bladder cancer as a technically feasible approach that is associated with a tolerable therapy-related morbidity. Additionally, satisfying clinical outcome is observed even in a substantial number of elderly patients.
Similar content being viewed by others
References
Skinner DG, Stein JP, Lieskovsky G, Skinner EC, Boyd SD, Figueroa A et al (1998) 25-year experience in the management of invasive bladder cancer by radical cystectomy. Eur Urol 33(Suppl 4):25–26
Figueroa AJ, Stein JP, Dickinson M, Skinner EC, Thangathurai D, Mikhail MS et al (1998) Radical cystectomy for elderly patients with bladder carcinoma: an updated experience with 404 patients. Cancer 83(1):141–147
Zebic N, Weinknecht S, Kroepfl D (2005) Radical cystectomy in patients aged > or = 75 years: an updated review of patients treated with curative and palliative intent. BJU Int 95(9):1211–1214
Rodel C, Grabenbauer GG, Kuhn R, Papadopoulos T, Dunst J, Meyer M et al (2002) Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol 20(14):3061–3071
Dunst J, Diestelhorst A, Kuhn R, Muller AC, Scholz HJ, Fornara P (2005) Organ-sparing treatment in muscle-invasive bladder cancer. Strahlenther Onkol 181(10):632–637
Arias F, Dominguez MA, Martinez E, Illarramendi JJ, Miquelez S, Pascual I et al (2000) Chemoradiotherapy for muscle invading bladder carcinoma. Final report of a single institutional organ-sparing program. Int J Radiat Oncol Biol Phys 47(2):373–378
Chen WC, Liaw CC, Chuang CK, Chen MF, Chen CS, Lin PY, et al. (2003) Concurrent cisplatin, 5-fluorouracil, leucovorin, and radiotherapy for invasive bladder cancer. Int J Radiat Oncol Biol Phys 56(3):726–733
Tekin A, Aki FT, Ozen H (2001) Radical cystectomy versus alternative treatments for muscle-confined bladder cancer. Int Urol Nephrol 33(2):357–362
Wilson JR, Urwin GH, Stower MJ (2005) The role of percutaneous nephrostomy in malignant ureteric obstruction. Ann R Coll Surg Engl 87(1):21–24
Lodde M, Palermo S, Comploj E, Signorello D, Mian C, Lusuardi L et al (2005) Four years experience in bladder preserving management for muscle invasive bladder cancer. Eur Urol 47(6):773–778; discussion 778–9
George L, Bladou F, Bardou VJ, Gravis G, Tallet A, Alzieu C et al (2004) Clinical outcome in patients with locally advanced bladder carcinoma treated with conservative multimodality therapy. Urology 64(3):488–493
Douglas RM, Kaufman DS, Zietman AL, Althausen AF, Heney NM, Shipley WU (1996) Conservative surgery, patient selection, and chemoradiation as organ-preserving treatment for muscle-invading bladder cancer. Semin Oncol 23(5):614–620
Mantadakis E, Panagiotidis C, Delakas D, Samonis G (2003) Symptomatic relief of patients with advanced bladder carcinoma after regional intra-arterial chemotherapy. Anticancer Res 23(6D):5143–5147
Hussain MH, Glass TR, Forman J, Sakr W, Smith DC, Al-Sarraf M et al (2001) Combination cisplatin, 5-fluorouracil and radiation therapy for locally advanced unresectable or medically unfit bladder cancer cases: a Southwest Oncology Group Study. J Urol 165(1):56–60; discussion 60–1
Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP, Raghavan D, Crawford ED (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349:859–866
Hautmann RE (1998) Complications and results after cystectomy in male and female patients with locally invasive bladder cancer. Eur Urol 33(Suppl 4):23–24
Teramukai S, Nishiyama H, Matsui Y, Ogawa O, Fukushima M (2006) Evaluation for surrogacy of end points by using data from observational studies: tumor downstaging for evaluating neoadjuvant chemotherapy in invasive bladder cancer. Clin Cancer Res 12(1):139–143
Cam K, Yildirim A, Ozveri H, Turkeri L, Akdas A (2002) The efficacy of neoadjuvant chemotherapy in invasive bladder cancer. Int Urol Nephrol 33(1):49–52
Nieuwenhuijzen JA, Horenblas S, Meinhardt W, van Tinteren H, Moonen LM (2004) Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer. BJU Int 94(6):793–797
Author information
Authors and Affiliations
Corresponding author
Additional information
U. Nagele and A. G. Anastasiadis have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Nagele, U., Anastasiadis, A.G., Merseburger, A.S. et al. The rationale for radical cystectomy as primary therapy for T4 bladder cancer. World J Urol 25, 401–405 (2007). https://doi.org/10.1007/s00345-007-0172-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-007-0172-9