[Local recurrence after radical cystectomy for cancer of the bladder]

The objective of the present study is to analyze the incidence, pathoanatomical characteristics, form of presentation and evolution of local relapses in patients undergoing radical cystectomy due to bladder cancer.

Analysis of our series of 170 bladder cancer cystectomies performed between 1986 and 1997 with a follow-up median of 51 months. 91% patients received no pre-operative treatment, 58% had localized disease (pT1-pT3a) while the remaining 42% had locally advanced disease (pT3b-pT4a). In 94% cases, a staging lymphadenectomy was performed which was pN0 in 84% instances, 21% patients underwent adjuvant chemotherapy.

The incidence of local relapse was 6.5%, 45.5% of which already showed distant metastasis at the time of diagnosis. Preoperative (9% vs 6.5%) or adjuvant (8.3% vs 6.7%) treatment did not decrease the incidence of relapse. Local relapse was more frequent in patients with higher histologic degree (p < 0.05) and in patients with locally advanced disease (9.7% vs 4%). Mean time between cystectomy and relapse detection was 10.5 (4-23) months and mean survival 3.8 (1-15) months.

Incidence of local relapse was 6.5%, half of the patients showing distant spread at the time of diagnosis. The type of pre- or post-operative treatment had not influence on the incidence of relapse. Patients with higher degrees and locally advanced stages had local relapse more frequently. The appearance of a local recurrence implies a bad prognosis with a medial survival of 3.8 months.