Dufour B, Housset M, Chrétien Y, Méjean A, Hallez J P, Maulard-Durdux C
Service d'Urologie, Hôpital Necker, Université Paris V.
Chirurgie. 1996;121(3):187-91; discussion 191-2.
Infiltrating bladder cancer is an extremely severe condition causing death within 5 years due to metastatic extension in one-half of the patients whatever the treatment. It is well known that radiotherapy is successful in treating some patients while partial exeresis (open surgery or laparoscopic surgery) is effective in others. Current chemotherapy protocols (usually well-tolerated) increase the efficacy of radiotherapy but it is surprising that over the last 10 years, total cystectomy has become the first line treatment proposed for patients with infiltrating bladder cancer. The operation is a major procedure leading to an important morbidity and mortality. Since 1988, we have decided not to rely on total cystectomy for such patients, but rather to use a treatment protocol associating endoscopic exercise of the tumour and radiochemotherapy. Our results allow confirmation that this protocol can provide curative treatment in certain cases without removing the entire bladder. We thus suggest that systematic amputation of the bladder for cancer is an obsolete procedure and raise the question as to the usefulness of total cystectomy in this disease?
浸润性膀胱癌是一种极其严重的疾病，无论采用何种治疗方法，一半的患者会因转移扩散在5年内死亡。众所周知，放射治疗对一些患者有效，而部分切除术（开放手术或腹腔镜手术）对另一些患者有效。目前的化疗方案（通常耐受性良好）提高了放射治疗的疗效，但令人惊讶的是，在过去10年中，全膀胱切除术已成为浸润性膀胱癌患者的一线治疗方案。该手术是一项大手术，会导致较高的发病率和死亡率。自1988年以来，我们决定不依赖全膀胱切除术来治疗此类患者，而是采用一种将肿瘤内镜切除与放化疗相结合的治疗方案。我们的结果证实，该方案在某些情况下无需切除整个膀胱即可提供根治性治疗。因此，我们认为系统性地为癌症切除膀胱是一种过时的手术，并对全膀胱切除术在这种疾病中的实用性提出质疑。
