[Study of survival after cystectomy for bladder cancer. Report of 504 cases]

Cystectomy is the reference treatment for invasive bladder cancer and superficial tumours with a high risk of recurrence. However, the long-term results of this treatment remain controversial. Progress in anaesthesia-intensive care and surgical techniques appear to have improved the prognosis of this disease over the last two decades. The availability of numerous adjuvant therapies (radiotherapy and chemotherapy) and the development of alternative conservative management therefore require a re-evaluation of the long-term results of cystectomy for bladder cancer performed over the last 20 years.

The case files of 504 consecutive patients undergoing cystectomy for bladder cancer in our department from 1981 to 1997 were reviewed. The operative and postoperative morbidity and actuarial survival by stage were studied. Histological prognostic factors and the influence of adjuvant therapies were also studied.

According to the TNM 97 classification, 55% of tumours (on the cystectomy specimen) were intravesical (< T3), and 70% of patients had negative lymph nodes (N0). The perioperative mortality was 1.56%. The overall survival at 2 years, 5 years and 10 years for the total patient population was 83.1%, 52.3% and 46.6%, respectively. The 5-year survival of tumours confined to the bladder (< T3) was 79.4% versus 27.5% when the tumour extended beyond the bladder (> T3). The lymph node status considerably influenced survival. N0, N1 and N2-3 patients had 5-year survival rates of 64%, 48% and 14%, respectively. Neoadjuvant chemotherapy or radiotherapy did not appear to improve survival.

Survival after cystectomy for bladder cancer essentially depends on pathological stage and lymph node status. Patients with a localized tumour have a 5-year survival greater than 80%. Prospective studies are required to determine the real benefit of adjuvant chemotherapy, as its value has not yet been formally demonstrated.