Radical cystectomy for carcinoma of the bladder.

A personal series of 50 radical cystectomies has been reviewed to decide whether it is a justifiable operation and, if so, when it should be performed. In spite of the fact that radical cystectomy had a higher operative mortality than simple cystectomy and was sometimes followed by lymphoedema, in patients with invaded iliac lymph nodes it was followed by a 25% 5-year survival. It appears, therefore, to be a justifiable procedure. It is recommended that simple cystectomy should be performed for patients with papillomatosis, carcinoma in situ, and as a salvage procedure after radiotherapy has failed, and that radical cystectomy should be reserved for elective cases in of invasive vesical tumours, and for those patients who are found at exploration to have obvious metastic deposits in the iliac lymph nodes.