黃品叡 1、沈正煌 1、周詠欽 1,2、林昌德 1、鄭明進 1
1 嘉義基督教醫院 外科部 泌尿科 2 亞洲大學 食品營養與保健生技學系
Pin-Jui Huang1, Yeong-Chin Jou1,2, Cheng-Huang Shen1, Chang-Te Lin1, Ming-Chin Cheng1
1Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital
2Department of Food Nutrition and Health Biotechnology, Asia University
Bladder cancer is a common disease nowadays, with an incidence of bladder cancer of approximately 2 to 5 percent among patients with microscopic hematuria and 10 to 20 percent among those with gross hematuria. In this case, we sincerely presented a case of bladder cancer with progression free survival for over fifteen years after operation. The literatures of postoperative clinical course and survival of bladder cancer were reviewed in this article.
This is a 64-year-old male denied history of systemic disease. According to his statement, painless gross hematuria had developed for one week, and he went to our outpatient department for further evaluation. Physical examination showed negative finding of abdominal tenderness and flank knocking pain. Bladder echo showed urinary bladder tumor. Further examination of intravenous urogram (IVU) revealed bladder tumor, which was compatible to sonographic finding. Abdominal computed tomography (CT) with contrast enhancement was arranged for staging, and the result showed bladder cancer with muscle layer invasion. There was no regional lymphadenopathy noted in this image. The clinical stage was cT2N0. Operation of radical cystoprostatectomy, bilateral ileal lymph node dissection, and neobladder reconstruction was performed smoothly in 2005. The patient admitted to surgical intensive unit after operation, and was transferred to general surgical ward on postoperative day 4. Vaccum ball was removed on postoperative day 11. The patient was discharged on postoperative 15 under stable condition. The final pathology showed low grade urothelial cell carcinoma, with pathological stage pT2N0.There was no recurrence episode after operation between 2005-2021. The patient was doing well without discomfort.
Discussion:
The debates between conservative treatment and operative treatment remained for decades. 2020 NCCN guideline of bladder cancer now indicated that in cases of bladder urothelial cell carcinoma (TCC), cT2N0, we had four arms to treat, including neoadjuvant chemotherapy followed by radical cystectomy, neoadjuvant chemotherapy followed by partial cystectomy in selected patients, radical cystectomy alone if not eligible to receive cisplatin-based chemotherapy, and concurrent chemoradiotherapy. In Herr et al, the patients with bladder TCC with pathological stage pT2-3 who received neoadjuvant chemotherapy with MVAC was reported to have a ten-year overall survival rate as 65%. In our case, the patient had received radical cystectomy and neobladder since 2005, and had regular follow-up every three months to 2021. The total follow-up duration was fifteen years and eleven months. There was no episode of recurrence, and the function of neobladder was doing well. No such case report about 15-year-outcome of postoperative clinical course of radical cystectomy and neobladder reconstruction was found in current literatures. And we sincerely presented this case for you.
This case reminds us that radical cystoprostatectomy plus ileal lymph node dissection and neobladder reconstruction could provide good survival outcome and prohibition of recurrence in case of bladder urothelial cell carcinoma with pT2 low grade. Such method could guarantee a better survival rate and progression free survival than conservative treatment.