Postdiversion precystectomy irradiation for cancer of the bladder

Radical cystectomy without radiation therapy for carcinoma of the bladder

A review of a 20-year experience of radical cystectomy identified 99 patients who had not undergone preoperative radiation therapy. The 5-year survival rate of patients with clinical high stage lesions (T3, T4a) was 40 per cent. Life-table analyses showed that survival rate in this group was comparable with that reported for other groups receiving preoperative radiation therapy. The pelvic recurrence rate was 9 per cent and was frequently related to either urethral or nodal disease. Unquantifiable patient selection factors may well limit the reliability of these results.

Supracystic urine diversion in patients with bladder carcinoma treated by cystectomy preceded by "short radiotherapy" (2000 R)

The authors assessed the results of supracystic urine diversion in 50 patients treated by cystectomy for bladder carcinoma who had "short radiotherapy" (2000 R) before the operation. It was found that preoperative radiotherapy caused no difficulties during subsequent cystectomy and the observed postoperative complications should be related rather to the surgical technique. It seems that indications to urine diversion by the method of Goodwin or Coffey should be considered with greater caution. In patients past the age of 65 years and those with more advanced neoplasms (T-3, T-4) bilateral ureterocutaneostomy should be performed more frequently for suprapubic urine diversion.

Case against routine 2-stage cystectomy for carcinoma of the bladder

A total of 25 patients with carcinoma of the bladder was subjected to urinary diversion, staged irradiation and total cystectomy. Of these 25 patients 1 died after cystectomy, for a mortality rate of 4 per cent. Complications occurred in 60 per cent of the patients. The projected 5-year survival rate is 49 per cent. We conclude that this protocol offers no advantages over radiation followed by cystectomy and diversion, and we believe that the procedure is unwarranted except in individualized instances.