[Importance of early cystectomy for the prognosis of cancer of bladder].

Between 1967 and 1985, 246 cystectomies were performed for the treatment of urothelial carcinoma of the bladder. Surgery-related mortality, initially 15%, was equal to 0% in 1985. Preoperative radiation therapy was not given. Despite strictly comparable T and N stages, prognosis was markedly better in patients who had undergone cystectomy as soon as the diagnosis of invasive cancer of the bladder was established than in patients who had undergone cystectomy after one or more recurrences of invasive carcinoma of the bladder and after transurethral resection. Twenty-six patients, undergoing cystectomy because of recurrence after curative radiation therapy, were the group with the worst 5--years survival--less than 10%. These results allow us to conclude that for the prognosis of carcinoma after total cystectomy, it is of the utmost importance to differentiate between an initially invasive tumor and a recurrence of an invasive carcinoma after transurethral resection. If performed immediately after infiltration has been demonstrated, cystectomy may greatly contribute to improving the long-term prognosis. As soon as the tumor extends to the lamina propria (pT1), one can no longer expect transurethral electroresection to suffice as reliable curative treatment of carcinoma of the bladder. As for the argument that the procedure is mutilating, one can counter with the increasing success in the last few years, of urinary derivation with continence, including bladder replacement or even total cystoprostatectomy, which does not result in impotence.