Stöckle M, Alken P, Engelmann U, Jacobi G H, Riedmiller H, Hohenfellner R
Department of Urology, Johannes Gutenberg University, Mainz Medical School, FRG.
Eur Urol. 1987;13(6):361-7. doi: 10.1159/000472824.
From 1967 to 1985, 246 cystectomies for treatment of transitional cell carcinoma of the urinary bladder were performed. Perioperative mortality decreased from 15% in the early years to 0% in 1985. Preoperative radiotherapy was not given. Patients who underwent cystectomy immediately following the diagnosis of invasive bladder carcinoma had a significantly better prognosis than those having cystectomy after recurrence of a transurethrally resected invasive carcinoma in spite of identical G and T criteria. A total of 26 patients who were cystectomized because of tumor recurrence after definitive radiotherapy (salvage cystectomy) represented the group with the worst prognosis: they had a 5-year survival rate of less than 10%. It is concluded from these results that recurrence of an infiltrating bladder tumor is an indication of poor prognosis. Early cystectomy after diagnosis of tumor infiltration can improve survival rates. Transurethral resection without adjuvant therapy cannot be regarded as reliable curative treatment of bladder cancer infiltrating the lamina propria (pT1). Modern surgical techniques of continent urinary diversion or total bladder replacement combined with sparing of the pelvic nerves (and thus preservation of potency) reinforce our view that radical cystoprostatectomy need no longer be regarded as mutilating surgery.
1967年至1985年期间，共实施了246例膀胱切除术以治疗膀胱移行细胞癌。围手术期死亡率从最初几年的15%降至1985年的0%。未进行术前放疗。尽管G和T标准相同，但诊断为浸润性膀胱癌后立即接受膀胱切除术的患者，其预后明显优于经尿道切除浸润性癌复发后接受膀胱切除术的患者。共有26例患者因根治性放疗后肿瘤复发而接受膀胱切除术（挽救性膀胱切除术），这组患者的预后最差：其5年生存率低于10%。从这些结果可以得出结论，浸润性膀胱肿瘤的复发预示着预后不良。肿瘤浸润诊断后早期行膀胱切除术可提高生存率。不进行辅助治疗的经尿道切除术不能被视为浸润固有层膀胱癌（pT1）的可靠根治性治疗方法。现代可控性尿流改道术或全膀胱替代术结合保留盆腔神经（从而保留性功能）的外科技术，强化了我们的观点，即根治性膀胱前列腺切除术不应再被视为致残性手术。
