Nagele Udo, Anastasiadis Aristotelis G, Merseburger Axel S, Corvin Stefan, Hennenlotter Jörg, Adam Melanie, Sievert Karl-Dietrich, Stenzl Arnulf, Kuczyk Markus A
Department of Urology, Eberhard-Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
World J Urol. 2007 Aug;25(4):401-5. doi: 10.1007/s00345-007-0172-9. Epub 2007 May 25.
Treatment of T4 bladder cancer patients remains a clinical challenge. Conservative management is often insufficient regarding local control, neoadjuvant chemotherapy delays definite treatment while leading to increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has also been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome, including therapy-related complications, in 20 T4 bladder cancer patients subjected to primary cystectomy. Twenty patients underwent radical cystectomy for T4 bladder cancer. At the time of surgery, 8 patients had regional lymph node metastases. The median postoperative follow-up was 13 months for the whole group. Mean duration of postoperative hospitalization was 19 days. Ten patients received no intra- or postoperative blood transfusions, whereas an average number of 3 blood units were administered in the remaining cases. Major therapy-associated complications were paresthesia affecting the lower extremities (n = 3) as well as insignificant pulmonary embolism, enterocutaneous fistulation and acute renal failure in one patient, respectively. At the time of data evaluation, 11 patients were still alive after a follow-up of 20 months. Four patients >or=70 years at the time of cystectomy were still alive after 11, 22 and 31 months following surgery, respectively. The current data demonstrate primary cystectomy for T4 bladder cancer as a technically feasible approach that is associated with a tolerable therapy-related morbidity. Additionally, satisfying clinical outcome is observed even in a substantial number of elderly patients.
T4期膀胱癌患者的治疗仍是一项临床挑战。保守治疗在局部控制方面往往不足，新辅助化疗会延迟明确治疗，同时在疾病过程中导致与治疗相关的发病率和死亡率增加。据报道，根治性膀胱切除术也与高并发症发生率和不理想的临床疗效相关。在此，我们报告了20例行根治性膀胱切除术的T4期膀胱癌患者的术后结果，包括与治疗相关的并发症。20例患者因T4期膀胱癌接受了根治性膀胱切除术。手术时，8例患者有区域淋巴结转移。全组患者术后中位随访时间为13个月。术后平均住院时间为19天。10例患者术中及术后未输血，其余患者平均输血3个单位。主要的与治疗相关的并发症分别为影响下肢的感觉异常（n = 3）以及1例患者出现的轻微肺栓塞、肠皮肤瘘和急性肾衰竭。在数据评估时，11例患者在随访20个月后仍存活。4例膀胱切除术时年龄≥70岁的患者在术后11、22和31个月后仍存活。目前的数据表明，T4期膀胱癌的根治性膀胱切除术是一种技术上可行的方法，与可耐受的治疗相关发病率相关。此外，即使在相当数量的老年患者中也观察到了令人满意的临床结果。
