Nagele Udo, Anastasiadis Aristotelis G, Merseburger Axel S, Hennenlotter Jörg, Horstmann Markus, Sievert Karl-Dietrich, Stenzl Arnulf, Kuczyk Markus A
Department of Urology, Eberhard-Karls-University, Tübingen, Germany.
Indian J Urol. 2008 Jan;24(1):95-8. doi: 10.4103/0970-1591.38610.
Whereas local control is often insufficient in conservative management of T4 bladder cancer, neoadjuvant chemotherapy delays definite treatment, which could result in increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome in 21 T4 bladder cancer patients subjected to primary cystectomy.
Twenty-one patients underwent radical cystectomy for T4 (T4a/b: 14 and seven cases, respectively) bladder cancer. At the time of surgery, eight patients had regional lymph node metastases (N2: 6; N3: 2). The average age was 64 (52-77) years (>/=70 years: n = 7). The postoperative follow-up was 13 (1-36) months for the whole group.
Mean duration of postoperative hospitalization was 19 (11-50) days. Whereas 10 patients received no intra - or postoperative blood transfusions, an average number of 3 (1-7) blood units were administered in the remaining cases. The mean postoperative hemoglobin value of patients not receiving any blood transfusions was 10 (8.5 - 11.4) g/dl. 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 (6-36) months. Four patients >/=70 years at the time of cystectomy were still alive 11, 11, 22 and 31 months following surgery, respectively.
Primary cystectomy for T4 bladder cancer is a technically feasible approach that is associated with a tolerable therapy-related morbidity/mortality. Additionally, a satisfactory clinical outcome is observed even in a substantial number of elderly patients.
鉴于T4期膀胱癌保守治疗时局部控制往往不足，新辅助化疗会延迟确定性治疗，这可能导致疾病过程中与治疗相关的发病率和死亡率增加。据报道，根治性膀胱切除术并发症发生率高且临床疗效不理想。在此，我们报告了接受根治性膀胱切除术的21例T4期膀胱癌患者的术后结果。
21例患者因T4期（T4a/b分别为14例和7例）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（N2：6例；N3：2例）。平均年龄为64（52 - 77）岁（≥70岁：n = 7）。全组术后随访13（1 - 36）个月。
术后平均住院时间为19（11 - 50）天。10例患者术中及术后未输血，其余患者平均输血3（1 - 7）单位。未输血患者术后平均血红蛋白值为10（8.5 - 11.4）g/dl。主要的与治疗相关的并发症为下肢感觉异常（n = 3），另有1例患者分别发生了轻微肺栓塞、肠皮肤瘘和急性肾衰竭。在数据评估时，随访20（6 - 36）个月后，11例患者仍存活。膀胱切除时年龄≥70岁的4例患者术后分别在11、11、22和31个月时仍存活。
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，其与治疗相关的发病率/死亡率是可耐受的。此外，即使在大量老年患者中也观察到了令人满意的临床结果。
