Improved radical surgery techniques offer positive results for bladder cancer patients

Bladder cancer patients undergoing radical surgery on university hospitals were able to benefit from excellent local control of the disease, acceptable clinical results and low mortality rate, according to research in the August issue of the journal Urology BJUI.

Researchers studied 2,287 patients who had a radical cystectomy operation, where the bladder is removed, along with the nearby tissues and organs as required. The operation was carried out in eight Canadian academic centres between 1998 and 2008.

The study found that there were three independent factors, apart from pathological stage surgery, which influenced survival of the patient. Patients who smoked had lower survival rates, while patients who had pelvic lymphadenectomy lymph nodes removed from the pelvic area – had higher survival rates, as well as patients receiving adjuvant chemotherapy, aimed at the destruction of microscopic cancer cells to the left after the operation.

However, the researchers found that neoadjuvant chemotherapy often prior to surgery is recommended to improve results tends to be used for bladder cancer in Canada.

"Recent advances in radiation combined with chemotherapy have the role of radical cystectomy (RC) with pelvic lymphadenectomy, which is used for treating muscle invasive and refractory non-muscle invasive bladder cancer challenged" says co-author Dr. Paasberg Kassouf, from McGill University Health Centre, Quebec, Canada.

"This bladder-conservation strategies are potentially attractive in terms of health-related quality of life and cancer results, but they only tend to work in highly selected patients.

"Advances in RC surgery have improved surgical care and techniques and reduced complications and mortality. The goal of our study was to evaluate a contemporary series of patients with bladder cancer to assess clinical outcomes and identify all the variables that affected their long-term health. "

Main findings of the study included:

--79% of the patients were male, the average age was 68 and the average follow-up of living patients was something more than 29 months. 66% reported a family history of tobacco smoking.

--More than three-quarters of the patients had high-grade tumors. Pathological specimen investigation showed no evidence of cancer in 7% of patients, muscle invasive disease in 73% and positive nodes involvement at 25%.

--Adjuvant chemotherapy was offered to 19% of the patients and neoadjuvant chemotherapy to just more than 3%.

--All patients earlier Transurethral resection of bladder tumors had undergone and the average time between this RC surgery was 49 days. This is similar to waiting times reported in international studies carried out in Sweden (49 days), the United States (42 days) and Germany (54 days).

--Mortality 30, 60 and 90-day were 1.3% and 2.6% 3.2% respectively. Cancer returned in 33% of patients within a median of 10 months. Local recurrence rates were 6% in the total Group and 4% in the group node-negative organ-confirmed.

--The five years of General, undisturbed recurrence and cancer-specific survival rates were 57%, 48% and 67% respectively.

--Multivariate analysis showed that lower pathological stage, negative surgical margins, receiving adjuvant chemotherapy, performance of pelvic lymphadenectomy and a lack of smoking were associated with long term illness-specific and General survival.

"Our study shows that very good results can be achieved when RC in academic centres within a universal health care system is running and that it is an effective clinical option for the treatment of patients with bladder cancer remains", says Dr. Kassouf.

Sources: Wiley-Blackwell, AlphaGalileo Foundation.