Early Radical Cystectomy

  • Jungyo Suh


Although the treatment of non-muscle invasive bladder cancer (NMIBC) is usually managed in a bladder-preserving manner, sometimes the performance of radical cystectomy cannot be avoided. Delayed cystectomy is related to worse oncological outcome; thus, early cystectomy (after bacillus Calmette-Guérin [BCG] failure) or immediate cystectomy (immediately after the diagnosis of NMIBC) is recommended. The 5-year disease-free survival after radical cystectomy in NMIBC patients is up to 80%. However, careful consideration of the risks and benefits of radical cystectomy is essential, because of the potential risk of complications and negative effects on the patient’s quality of life.


Radical cystectomy Indication Early radical cystectomy Lymphovascular invasion Carcinoma in situ BCG failure 


  1. 1.
    Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol. 2016;196:1021–9. Scholar
  2. 2.
    Mathieu R, Lucca I, Rouprêt M, Briganti A, Shariat SF. The prognostic role of lymphovascular invasion in urothelial carcinoma of the bladder. Nat Rev Urol. 2016;13:471–9. Scholar
  3. 3.
    Kim HS, Kim M, Jeong CW, Kwak C, et al. Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: a systematic review and meta-analysis. Urol Oncol. 2014;32:1191–9. Scholar
  4. 4.
    Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J. Improving selection criteria for early cystectomy in high-grade T1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol. 2015;33:643–50. Scholar
  5. 5.
    Kunju LP, You L, Zhang Y, Daignault S, Montie JE, Lee CT. Lymphovascular invasion of urothelial cancer in matched transurethral bladder tumor resection and radical cystectomy specimens. J Urol. 2008;180:1928–32. Scholar
  6. 6.
    Casey RG, Catto JWF, Cheng L, Cookson MS, Herr H, Shariat S, et al. Diagnosis and management of urothelial carcinoma in situ of the lower urinary tract: a systematic review. Eur Urol. 2015;67:876–88. Scholar
  7. 7.
    Sylvester RJ, Van Der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49:466–75. Scholar
  8. 8.
    Palou J, Baniel J, Klotz L, Wood D, Cookson M, Lerner S, et al. Urothelial carcinoma of the prostate. Urology. 2007;69:50–61. Scholar
  9. 9.
    Moschini M, Soria F, Susani M, Korn S, Briganti A, Roupret M, et al. Impact of the level of urothelial carcinoma involvement of the prostate on survival after radical cystectomy. Bladder Cancer. 2017;3:161–9. Scholar
  10. 10.
    Seisen T, Compérat E, Léon P, Roupret M. Impact of histological variants on the outcomes of nonmuscle invasive bladder cancer after transurethral resection. Curr Opin Urol. 2014;24:524–31. Scholar
  11. 11.
    Alvarado-Cabrero I, Sierra-Santiesteban FI, Mantilla-Morales A, Hernández-Hernandez DM. Micropapillary carcinoma of the urothelial tract: a clinicopathologic study of 38 cases. Ann Diagn Pathol. 2005;9:1–5. Scholar
  12. 12.
    Kamat AM, Gee JR, Dinney CPN, Grossman HB, Swanson DA, Millikan RE, et al. The case for early cystectomy in the treatment of nonmuscle invasive micropapillary bladder carcinoma. J Urol. 2006;175:881–5. Scholar
  13. 13.
    Wright JL, Black PC, Brown GA, Porter MP, Kamat AM, Dinney CP, et al. Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of the bladder. J Urol. 2007;178:2302–7. Scholar
  14. 14.
    Bansal A, Kumar N, Sharma SC. Sarcomatoid variant of urothelial carcinoma of the urinary bladder. J Cancer Res Ther. 2013;9:571–3. Scholar
  15. 15.
    Kaimakliotis HZ, Monn MF, Cheng L, Masterson TA, Cary KC, Pedrosa JA, et al. Plasmacytoid bladder cancer: variant histology with aggressive behavior and a new mode of invasion along fascial planes. Urology. 2014;83:1112–6. Scholar
  16. 16.
    Cambier S, Sylvester RJ, Collette L, Gontero P, Brausi MA, Van Andel G, et al. EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage ta-T1 urothelial bladder cancer patients treated with 1-3 years of maintenance bacillus Calmette-Guérin. Eur Urol. 2016;69:60–9. Scholar
  17. 17.
    Tan WS, Rodney S, Lamb B, Feneley M, Kelly J. Management of non-muscle invasive bladder cancer: a comprehensive analysis of guidelines from the United States, Europe and Asia. Cancer Treat Rev. 2016;47:22–31. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Jungyo Suh
    • 1
  1. 1.Department of UrologySeoul National University HospitalSeoulSouth Korea

Personalised recommendations