Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20years experience at Tohoku University

Background: Neobladder, using the intestine, was performed after neoadjuvan t therapy and total cystectomy as a treatment for invasive bladder cancer. Methods: Between January 1977 and April 1997, an ileocecal neobladder was u sed for 23 patients and a sigmoid neobladder was chosen for use in 32 patie nts. For the diagnosis of invasive bladder cancer and the evaluation of neo adjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tum or and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bip edal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space. Results: Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 p atients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging . Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor sta ge NO in all patients and lymph node dissection revealed pN0 in four patien ts. Of the five patients who received 40 Gy irradiation, none had any posto perative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully tre ated by transurethral resection. Two patients treated prior to 1985 experie nced local recurrence. Neither was treated by neoadjuvant therapy. Eight pa tients who died after 1985 had metastatic cancer, but none had local recurr ence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux. Conclusions: Neoadjuvant therapy seems to reduce local recurrence in invasi ve bladder cancer. The sigmoid colon may be suitable for neobladder.