Radical cystectomy for urothelial carcinoma of the bladder: an analysis of perioperative and survival outcome

OBJECTIVE To review the outcomes in a large group of patients treated with radical cystectomy (RC) for urothelial cancer (UC) of the bladder, by one surgical team. PATIENTS AND METHODS In all, 504 patients had RC for UC of the bladder between 1992 and 2007; 432 met the inclusion criteria and were analysed for survival and disease recurrence. RESULTS Of the 432 patients, (mean age 69 years; mean follow‐up 38 months, range 1–172), 240 (56%) and 179 (41%) had an ileal conduit and orthotopic neobladder for urinary diversion, respectively. The mortality rate within 30 days of RC was 2%; 105 (24%) patients developed local and/or distant recurrence with a mean interval of 13.6 months. The overall survival, recurrence‐free survival (RFS) and disease‐specific survival (DSS) at 5 years was 58%, 64% and 74%, respectively, and 43%, 62% and 68% at 10 years. The 5‐year RFS and DSS for those with organ‐confined, node‐negative tumours was 81% and 91%, compared to 46% and 56% in those with extravesical extension and lymph node‐negative tumours. The RFS and DSS of patients with lymph node metastasis at 5 years was 29% and 40%, respectively. CONCLUSION Our study reaffirms that RC with bilateral pelvic lymph node dissection offers a reasonable possibility of disease control at 5 years, with a DSS of 74%. However, there is a need for an earlier diagnosis and effective systemic therapy if additional gains in survival are to be delivered.