SURVIVAL AFTER PELVIC LYMPHADENECTOMY AND RADICAL CYSTECTOMY IN PATIENTS WITH LYMPH-NODE METASTATIC TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

The objective of this study was to determine the clinical outcome of p atients with invasive transitional cell carcinoma of the bladder and p elvic lymph node metastases treated by radical cystectomy and bilatera l pelvic lymphadenectomy in a single institution. From January 1980 to December 1993, 116 patients with transitional cell carcinoma of the b ladder underwent bilateral pelvic lymphadenectomy and radical cystecto my at the Montreal General Hospital. Of these patients, 25 (21.6%) wer e found to have nodal metastases and form the basis of this retrospect ive analysis. Extent of nodal disease was as follows: 7 (28%) with N1, 17 (68%) with N2, and 1 (4%) patient with N3 disease. Of the 25 patie nts, 9 (36%) were alive with no evidence of disease and 1 (4%) died at 42 months from cardiovascular disease without clinical evidence of ca ncer recurrence. The median follow-up interval for these 10 patients w as 26.5 months (mean, 31.4 months; range, 7-104 months). Fourteen (56% ) patients died of recurrent bladder cancer and one patient was alive with systemic disease at 14 months. The median survival was estimated at 27 months, with 73% alive at 1 year, 51% alive at 2 years, and 33% alive at 3 years. Our data suggests that long-term survival free of di sease can be achieved by radical surgery in some patients with node-po sitive bladder cancer.