Department of Urology, University Hospital Tuebingen, Germany.
Eur Urol. 2013 Jan;63(1):45-57. doi: 10.1016/j.eururo.2012.08.009. Epub 2012 Aug 14.
New guidelines of the International Consultation on Urological Diseases for the treatment of muscle-invasive bladder cancer (MIBC) have recently been published.
To provide a comprehensive overview of the current role of radical cystectomy (RC) in MIBC.
A detailed Medline analysis was performed for original articles addressing the role of RC with regard to indication, timing, surgical extent, perioperative morbidity, oncologic outcome, and follow-up. The analysis also included radiation-based bladder-preserving strategies.
The major findings are presented in an evidence-based fashion and are based on large retrospective unicenter and multicenter series with some prospective data.
Open RC is the standard treatment for locoregional control of MIBC. Delay of RC is associated with reduced cancer-specific survival. In males, standard RC includes the removal of the bladder, prostate, seminal vesicles, and distal ureters; in females, RC includes an anterior pelvic exenteration including the bladder, entire urethra and adjacent vagina, uterus, and distal ureters. A procedure sparing the urethra and the urethra-supplying autonomous nerves can be performed in case of a planned orthotopic neobladder. Further technical variations (ie, seminal-sparing or vaginal-sparing techniques) aimed at improving functional outcomes must be weighed against the risk of a positive margin. Laparoscopic surgery is promising, but long-term data are required prior to accepting it as an option equivalent to the open procedure. Lymphadenectomy should remove all lymphatic tissue around the common iliac, external iliac, internal iliac, and obturator region bilaterally. Complications after RC should be reported according to the modified Clavien grading system. In selected patients with MIBC, bladder-preserving therapy with cystectomy reserved for tumor recurrence represents a safe and effective alternative to immediate RC.
最近发布了国际泌尿外科疾病咨询委员会关于肌层浸润性膀胱癌（MIBC）治疗的新指南。
提供根治性膀胱切除术（RC）在 MIBC 中的当前作用的全面概述。
对涉及 RC 适应证、时机、手术范围、围手术期发病率、肿瘤学结果和随访的原始文章进行了详细的 Medline 分析。分析还包括基于放射的膀胱保留策略。
主要发现以循证的方式呈现，基于大型回顾性单中心和多中心系列，并有一些前瞻性数据。
开放式 RC 是 MIBC 局部区域控制的标准治疗方法。RC 的延迟与癌症特异性生存降低相关。在男性中，标准 RC 包括膀胱、前列腺、精囊和远端输尿管的切除；在女性中，RC 包括包括膀胱、整个尿道和相邻阴道、子宫和远端输尿管的前盆腔切除术。在计划进行原位尿流改道的情况下，可以进行保留尿道和供应尿道自主神经的手术。进一步旨在改善功能结果的技术变化（即保留精子或保留阴道的技术）必须权衡阳性切缘的风险。腹腔镜手术很有前途，但在接受其作为与开放式手术等同的选择之前，需要长期数据。淋巴结切除术应切除双侧髂总、髂外、髂内和闭孔区域的所有淋巴组织。RC 后并发症应根据改良 Clavien 分级系统报告。在 MIBC 的选定患者中，保留膀胱的治疗方法，即仅在肿瘤复发时进行膀胱切除术，是一种安全有效的替代即时 RC 的方法。
