Organ preservation for muscle-invasive bladder cancer by transurethral resection
Dan Leibovici1, Wassim Kassouf, Louis L Pisters
1Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Objectives:
To determine the feasibility of bladder preservation using transurethral resection for patients with muscle-invasive cancer and to determine the proportion of patients with muscle-invasive disease who would be eligible for this approach.
Methods:
A retrospective review demonstrated that 327 patients with muscle-invasive bladder cancer were treated in our institution from 1997 to 2002. Resection was repeated in all patients, and bladder preservation was offered to patients with no residual tumor, normal examination findings under anesthesia, and normal upper urinary tract findings. Patients were followed up by routine cystoscopy for a median of 2.45 years. The study endpoints included overall and disease-specific survival rates, the need for additional systemic chemotherapy, and cystectomy-free survival.
Results:
Of 327 patients, 35 (11%) were eligible for bladder preservation; 27 elected to pursue this approach and 8 opted for immediate cystectomy. Of the 27 patients, 15 experienced subsequent tumor recurrence, 8 of whom underwent radical cystectomy. Thus, the bladder was preserved in 19 (70%) of the 27 patients. Of the patients who underwent cystectomy, 5 also received chemotherapy. Five patients died, including three of unrelated diseases, one of metastatic cancer, and one of surgical complications. The overall and disease-specific survival rate was 81% and 93%, respectively.
Conclusions:
Bladder preservation using transurethral resection is feasible in selected patients. Only a small proportion of patients with muscle-invasive bladder cancer, however, are candidates for this approach.
Insights
Bladder preservation after transurethral resection is feasible for select muscle-invasive bladder cancer patients. However, only a small percentage of eligible candidates can pursue this approach.
Area of Science:
- Urology
- Oncology
Background:
- Muscle-invasive bladder cancer (MIBC) traditionally requires radical cystectomy.
- Transurethral resection (TUR) offers a potential bladder-sparing alternative for select patients.
Purpose of the Study:
- To assess the feasibility of bladder preservation using TUR for MIBC.
- To identify the proportion of MIBC patients eligible for this bladder-sparing strategy.
Main Methods:
- Retrospective review of 327 MIBC patients treated between 1997-2002.
- Eligibility for bladder preservation required no residual tumor post-resection, normal anesthesia examination, and normal upper urinary tract findings.
- Patients were followed via cystoscopy with endpoints including survival and cystectomy-free survival.
Main Results:
- 11% (35/327) of patients were eligible for bladder preservation; 27 opted for it.
- Bladder was preserved in 70% (19/27) of patients who chose this approach.
- Overall survival was 81% and disease-specific survival was 93%.
Conclusions:
- Transurethral resection allows for feasible bladder preservation in carefully selected MIBC patients.
- The proportion of MIBC patients suitable for bladder preservation via TUR is limited.
