Radical Cystectomy Surgery Benefits Bladder Cancer Patients

Bladder cancer patients who undergo radical cystectomy (RC) at university hospitals can benefit from excellent local control of the disease, acceptable clinical outcomes, and low death rates, according to a new study.

Researchers at McGill University Health Center (Montreal, Canada) studied 2,287 patients (median age 68 years, 79% male) who underwent RC at eight Canadian academic centers between 1998 and 2008; the average follow-up of live patients was 29 months. More than three-quarters of the patients had high-grade tumors, and 66% reported a family history of tobacco smoking. Pathological specimen examination revealed no evidence of cancer in 7% of patients, muscle invasive disease in 73%, and positive nodal involvement in 25%. Adjuvant chemotherapy was offered to 19% of patients, and neoadjuvant chemotherapy to just over 3%.

The results showed that the 30, 60, and 90-day death rates were 1.3%, 2.6%, and 3.2% respectively. Cancer returned in 33% of patients within a median of 10 months, and local recurrence rates were 6% in the overall group and 4% in the organ-confirmed node-negative group. The five-year overall, recurrence-free, and cancer-specific survival rates were 57%, 48%, and 67% respectively. In all, lower pathological stage, negative surgical margins, receipt of adjuvant chemotherapy, performance of pelvic lymphadenectomy, and an absence of smoking were associated with prolonged disease-specific and overall survival. The study was published in the August 2011 issue of BJUI.

“Advances in RC surgery have improved surgical care and techniques and reduced complications and mortality rates,” said lead author Wassim Kassouf, MD, of the division of urology. “The aim of our study was to … assess the clinical outcomes and identify any variables that affected their long-term health. Very good results can be achieved when radical cystectomy is performed at academic centers within a universal healthcare system.”

Adjuvant therapy involves any treatment given after primary therapy to increase the chance of long-term survival; neoadjuvant therapy is treatment given before primary therapy. One of the findings of the study was that neoadjuvant chemotherapy tends to be under utilized for bladder cancer in Canada.

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