Li-Hsien, Tsai, Po-Jen Hsiao, Guang-Heng Chen, Chao-Hsiang Chang, Hsi-Chin Wu, Chi-Rei Yang

Department of Urology, China Medical University Hospital

部分膀胱切除術治療膀胱癌: 單一醫學中心之成果

蔡禮賢,蕭博任 ,陳冠亨, 張兆祥, 吳錫金, 楊啟瑞

中國醫藥大學附設醫院泌尿科

    Radical cystectomy with pelvic lymph node dissection remains the gold standard of invasive bladder urothelial carcinoma. However, radical cystectomy with urinary diversion carries a high risk of perioperative complication and has a major impact on each patient’s quality of life. Partial cystectomy is one surgical procedure for the patient with a solitary lesion in the suitable location. Partial cystectomy is though a shorter, less adverse effect compared with the radical operation and do no require urinary diversion. Recent studies also reported acceptable oncologic outcomes in carefully selected patients while offering improved quality of life. We retrospectively reviewed and analyzed all cases in a single medical center.

 

     Patients who underwent partial cystectomy for primary bladder cancer from 2001 to 2016 were identified from our database. Clinical, pathological and follow-up data were reviewed.

 

    A total 22 patients received partial cystectomy due to bladder urothelial cancer were included in the study. There were 18 males and 4 females patients. The mean age was 65±10 years old. The tumor positions were lateral, anterior, posterior, dome, bladder neck and just near UO: 8 ,2 ,6 ,6 ,3 and 2 , respectively. Eighteen patients had a single lesion and 4 patients had multiple lesions. Nineteen patients were categorized into clinical stage T2N0M0 and other 3 patients were staged as clinical stage T2N1M1, T1N0M0, and TaN0M0. Neoadjuvant chemotherapy was performed on 9 patients. Fourteen patients received open method operation while 3 and 5 patients received laparoscopic and robotic surgery, respectively. The average blood loss during the operation was 163ml. Ten patients reach ypT0 on the final pathology report. Four perioperative risks were noted after the operation, including one paralytic ileus, two wound infection and one pulmonary embolism. Bladder recurrence was noted in 8 patients during follow-up including four Tcis and two Ta bladder tumors. There were two patients developed lymph metastasis or visceral metastasis. Mean recurrence-free survival for these patients were 14±13 months. One of the 22 patients died of bladder cancer with multiple visceral metastases. Whether patients received neoadjuvant chemotherapy or achieved final pathology stage ypT0 seem reduced bladder recurrence rate but not to a significant level (P=0.09, 0.4, respectively). Several risk factors may lead to recurrences such as multiple tumors, laparoscopic surgery, the tumor located in diverticulum or ureter orifice.

 

Conclusion:

    Patients treated with partial cystectomy for primary bladder cancer had satisfactory cancer control and favorable perioperative morbidity consistent with other contemporary reports. There was still no consensus about patient selection criteria for partial cystectomy. Prospective, randomized studies including patients selection and comparison between bladder sparing treatment modalities and radical cystectomy are needed in the future.