[Surgical treatment of urinary bladder cancer. Indications, technics, and general results].

OBJECTIVE

To analyze the results and indications of the three surgical techniques commonly utilized alone or as part of other treatments for infiltrating bladder tumors.

METHODS

Our series of patients with infiltrating bladder tumors are analyzed and the literature reviewed.

RESULTS

Transurethral resection (TUR) is essential for tumor staging and is controversial as a therapeutic approach. However, using stringent selection criteria and careful follow-up, retrospective studies have reported survival rates of 82-83%, which are similar to those of radical cystectomy in similar cases, but with bladder preservation rates of 67%-75%. However, only 19-21% of patients can benefit from this surgical technique and the selection criteria are relatively subjective. Partial cystectomy achieves a considerable survival rate of 40-80%, but very stringent selection criteria must be met, which are partly similar to those of the previously mentioned technique, therefore it is not an alternative to TUR since it is a more aggressive surgical procedure. It could be an alternative to radical cystectomy in the more advanced stages of the disease, but although it may be technically biologically feasible, there is a high risk of local and cicatricial recurrence and difficulty in the early detection of recurrence caused by the anatomical disturbance in the bladder wall. For all the foregoing, partial cystectomy is utilized only for very specific cases of urachal carcinoma, as a palliative approach instead of cystectomy, or for areas that are not accessible to TUR. However, although it has specific indications, it has been demonstrated to be effective in the evaluation of the response to chemotherapy and systematically utilized in bladder preservation programs.

CONCLUSIONS

Radical cystectomy continues to be the standard treatment for infiltrating bladder tumors with overall 5-year survival rates in recent series ranging from 56%-72%, and is related with the pathological stage and particularly nodal involvement. The morbidity has dropped and the operative mortality rate is about 2%. Quality of life has also improved with the new techniques of urinary diversion, especially orthotopic diversion.