Improved Radical Surgery Techniques Improve Bladder Cancer Outcomes
Bladder cancer patients who have radical surgery can benefit from local control of the disease, acceptable clinical outcomes and low death rates, according to research in the August issue of British Journal of Urology International. Researchers studied 2,287 patients who had radical cystectomy surgery, where the bladder is removed, together with nearby tissue and organs as required. The surgery was performed at eight Canadian academic centers between 1998 and 2008.
The study found that there were three independent factors, apart from pathological stage at surgery, that influenced survival rates. 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 did patients who received adjuvant chemotherapy, which aims to destroy microscopic cancer cells left after surgery. However, the researchers found that neoadjuvant chemotherapy - which is often recommended prior to surgery to improve outcomes - tends to be under utilised for bladder cancer in Canada.
"Recent advances in combined radiation with chemotherapy have challenged the role of radical cystectomy (RC) with pelvic lymphadenectomy, which is used to treat muscle invasive and refractory non-muscle invasive bladder cancer," says co-author Dr Wassim Kassouf, from McGill University Health Center, Quebec, Canada. "These bladder-preservation strategies are potentially attractive in terms of health-related quality of life and cancer outcomes, 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 rates."
Key findings of the study included:
- The 30, 60 and 90-day death rates were 1.3 percent, 2.6 percent and 3.2 percent respectively. Cancer returned in 33 percent of patients within a median of 10 months.
- Local recurrence rates were six percent in the overall group and four percent in the organ-confirmed node-negative group.
- The five-year overall, recurrence-free and cancer-specific survival rates were 57 percent, 48 percent and 67 percent respectively.
- Multi-variate analysis showed that lower pathological stage, negative surgical margins, receipt of adjuvant chemotherapy, performance of pelvic lymphadenectomy and an absence of smoking were associated with prolonged disease-specific and overall survival.