RADICAL CYSTECTOMY FOR STAGE-TA, STAGE-TIS AND STAGE-T1 TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Between January 1969 and January 1990, 531 patients underwent bilatera l pelvic lymph node dissection and radical cystectomy for the manageme nt of transitional cell carcinoma of the bladder. Of these procedures 220 were performed for clinical stage Ta (31 patients), Tis (23) or T1 (166) disease, which was either high grade or recalcitrant to transur ethral resection and/or intravesical chemotherapy. This subgroup of pa tients was studied to evaluate the outcome of recurrent or chemotherap y resistant superficial transitional cell carcinoma of the bladder aft er radical cystectomy. The operative mortality rate for the group was 2.3% and the overall complication rate was 20.4%. The pelvic recurrenc e rate was 5.9%. The 5-year cancer-specific survival rates for patient s with pathological stage Ta (11), Tis (19), T0 (43) and T1 (91) disea se were 88%, 100%, 80% and 76%, respectively. The 10-year cancer-speci fic survival rates were 75%, 92%, 66% and 62%, respectively. A total o f 74 patients received preoperative radiation therapy (2,000 rad) but they had no better 5-year cancer-specific survival rates than did noni rradiated patients. Transurethral resection and/or preoperative radiat ion therapy resulted in a pathological status of TO in 43 patients but this did not confer a survival advantage. Although bladder preservati on is preferable, low operative mortality and pelvic recurrence rates, as well as new methods of continent urinary diversion continue to mak e radical cystectomy the definitive form of therapy for patients with superficial disease recalcitrant to transurethral therapy.