Radical Total Cystectomy for Cancer of the Bladder: 230 Consecutive Cases Five Years Later

Whitmore, Willet F.; Marshall, Victor F.

doi:10.1016/s0022-5347(17)65058-4

Cited by 242 publications

(48 citation statements)

References 23 publications

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“…The early results and outcome of radical cystectomy were disappointing and questionable [14]. Lack of universal acceptance of this procedure was largely a result of the considerable morbidity, in particular the need for improvements in urinary diversion.…”

Section: Discussionmentioning

confidence: 99%

“…Over the past 30years, radical cystectomy has emerged as a standard therapy for patients with high-grade, invasive bladder cancer. Radical cystectomy with pelvic iliac lymphadenectomy is an ideal form of therapy for this disease, as it effectively removes the primary bladder tumour and the regional lymph nodes that may contain metastases in up to 25% of patients undergoing the procedure [3].The early results and outcome of radical cystectomy were disappointing and questionable [14]. Lack of universal acceptance of this procedure was largely a result of the considerable morbidity, in particular the need for improvements in urinary diversion.…”

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confidence: 99%

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Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high‐grade, invasive bladder cancer

Stein

Skinner

2003

BJU International

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improved the quality of life of patients requiring bladder removal, eliminating the need for urostomy appliances, cutaneous stomas and the need for catheterization in most instances [5]. For these reasons radical cystectomy has become a standard therapy for high-grade, invasive bladder cancer.The purpose of this report is to update a previous review of our institutional clinical experience with high-grade, invasive bladder cancer in a large group of patients treated uniformly with radical cystectomy and extended bilateral pelvic lymphadenectomy over a 25-year period, with a long-term follow-up [3]. These outcome data provide prognostic information for physicians treating patients with bladder cancer, and set a standard to which other therapies can be compared. PATIENTS AND METHODSFrom 1971 to 1997, 1054 patients (843 men, 80%, and 211 women; median age 66years, range 22-93) underwent radical cystectomy for primary TCC of the bladder with the intent to cure. The results from these patients were reported previously [3]. The indication for cystectomy was based on cystoscopic and biopsy findings including: tumour invasion of the muscularis propria or prostatic stroma; high-grade, invasive tumours associated with carcinoma in situ (CIS); CIS refractory to intravesical chemotherapy or immunotherapy; recurrent multifocal superficial disease refractory to repeat transurethral resection with/without intravesical therapy; and tumours involving a bladder diverticulum. Overall, 94% of patients had high-grade bladder tumours.All patients underwent a previously described, standard surgical procedure including a meticulous bilateral pelvic iliac lymphadenectomy with en bloc radical cystectomy, and urinary diversion [6]. The specific form of urinary diversion, either incontinent (conduit) or continent (cutaneous or orthotopic), relates primarily to the particular era in which the urinary system was reconstructed (Table 1). A conduit form of diversion was replaced by a continent cutaneous form of reconstruction in 1982, with orthotopic reconstruction ultimately becoming the primary form of urinary diversion in 1986 for men [7], and in 1992 for women [8] at our institution.The use of adjuvant therapies (radiation and/or chemotherapy) developed over the 25years of treating patients for bladder cancer. From 1971 to 1978, 97 patients received a high-dose short course of radiation therapy ( ª 1600rads) delivered over 4days immediately before cystectomy; these patients were compared with 248 of similar pathological stage who underwent cystectomy between 1979 and 1986, and who received no adjuvant radiation or systemic chemotherapy [9]. There was no significant difference in time to recurrence or overall survival between the groups. Furthermore, there was no difference in the incidence of pelvic recurrence.From 1978 to the present, systemic chemotherapy was selectively given to 272 patients (26%), i.e. 211 in an adjuvant setting after surgery, based on pathological analysis of the primary bladder tumour and regional lymph nodes, and 48...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high‐grade, invasive bladder cancer

Stein

Skinner

2003

BJU International

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“…Whitmore and Marshall reported that a survival benefit was possible when lymphadenectomy was combined with cystectomy [15]. Lymphadenectomy during radical cystectomy might serve both a diagnostic and a therapeutic purpose.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy

Kang

Choi

et al. 2009

Korean J Urol

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Purpose:We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. Materials and Methods: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. Results: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5±145.1 minutes, and the mean estimated blood loss was 346.8±205.9 ml. The mean time for PLND was 106.7±25.2 minutes in patients with ePLND and 72.1±14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23. 5±12.8 (range, 8-50)

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“…The use of preoperative radiotherapy has been based on the observation that the survival rate for patients who received radiotherapy was on average twice as high as that for patients who did not receive irradiation (10,11). However, the indications and doses of preoperative radiotherapy are not clear at present (2).…”

Section: Discussionmentioning

confidence: 99%

Results of Cystectomy with and Without Preoperative Radiotherapy in Carcinoma of the Urinary Bladder

et al. 1990

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Radical Total Cystectomy for Cancer of the Bladder: 230 Consecutive Cases Five Years Later

Cited by 242 publications

References 23 publications

Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high‐grade, invasive bladder cancer

Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high‐grade, invasive bladder cancer

The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy

Results of Cystectomy with and Without Preoperative Radiotherapy in Carcinoma of the Urinary Bladder

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