Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.
Semin Oncol. 2012 Oct;39(5):573-82. doi: 10.1053/j.seminoncol.2012.08.012.
Radical cystectomy with bilateral pelvic lymphadenectomy remains the gold standard in the surgical management of muscle-invasive urothelial carcinoma of the bladder and provides optimal locoregional cancer control in conjunction with perioperative cisplatin-based chemotherapy. Improvements in preoperative staging can aid in the identification of patients who may optimally benefit from neoadjuvant chemotherapy and determine candidacy for orthotopic neobladder reconstruction. Innovations in surgical technique and perioperative care have helped to minimize patient morbidity and preserve long-term urinary and sexual function while maintaining oncologic control. The use of minimally invasive surgical approaches has grown dramatically in urologic surgery over the past decade and the preliminary results of robot-assisted laparoscopic radical cystectomy have been reported recently. Anatomic pelvic and iliac lymphadenectomy is crucial for precise pathologic staging and may improve patient survival by removing micrometastatic disease.
根治性膀胱切除术加双侧盆腔淋巴结清扫术仍然是肌层浸润性膀胱癌的金标准治疗方法，结合围手术期顺铂为基础的化疗可实现最佳局部区域肿瘤控制。术前分期的改进有助于识别可能从新辅助化疗中获益最大的患者，并确定进行原位新膀胱重建的资格。手术技术和围手术期护理的创新有助于最大限度地减少患者的发病率，并在保持肿瘤控制的同时保留长期的尿控和性功能。在过去十年中，微创外科方法在泌尿外科手术中得到了迅猛发展，最近报道了机器人辅助腹腔镜根治性膀胱切除术的初步结果。解剖性盆腔和髂淋巴结清扫术对于准确的病理分期至关重要，通过清除微转移疾病可能改善患者的生存。
