Radical cystectomy for urothelial carcinoma of the bladder: an analysis of perioperative and survival outcome

Abstract

Objective: To review the outcomes in a large group of patients treated with radical cystectomy (RC) for urothelial cancer (UC) of the bladder, by one surgical team.

Patients and methods: In all, 504 patients had RC for UC of the bladder between 1992 and 2007; 432 met the inclusion criteria and were analysed for survival and disease recurrence.

Results: Of the 432 patients, (mean age 69 years; mean follow-up 38 months, range 1-172), 240 (56%) and 179 (41%) had an ileal conduit and orthotopic neobladder for urinary diversion, respectively. The mortality rate within 30 days of RC was 2%; 105 (24%) patients developed local and/or distant recurrence with a mean interval of 13.6 months. The overall survival, recurrence-free survival (RFS) and disease-specific survival (DSS) at 5 years was 58%, 64% and 74%, respectively, and 43%, 62% and 68% at 10 years. The 5-year RFS and DSS for those with organ-confined, node-negative tumours was 81% and 91%, compared to 46% and 56% in those with extravesical extension and lymph node-negative tumours. The RFS and DSS of patients with lymph node metastasis at 5 years was 29% and 40%, respectively.

Conclusion: Our study reaffirms that RC with bilateral pelvic lymph node dissection offers a reasonable possibility of disease control at 5 years, with a DSS of 74%. However, there is a need for an earlier diagnosis and effective systemic therapy if additional gains in survival are to be delivered.