A stage specific approach to tumor surveillance after radical cystectomy for transitional cell carcinoma of the bladder

Purpose: Surveillance protocols after radical surgery for genitourinary tum ors typically do not consider that the risk of recurrence is stage dependen t. We describe the development of a stage specific protocol for monitoring patients with transitional cell carcinoma for tumor recurrence and conduit complications after radical cystectomy. Materials and Methods: The records of 382 patients with transitional cell c arcinoma who underwent cystectomy in 1986 to 1994 were reviewed for the dat es and presenting symptoms of local and distant recurrences, and the result s of radiological imaging studies and liver function tests. Based on the di vision of patients into pathological stages of pT1, pT2 and pT3 groups, we developed a new transitional cell carcinoma surveillance protocol. Results: Of 97 patients with transitional cell carcinoma metastases 72 (74% ) were asymptomatic, including 43 with metastases detected by routine chest x-rays (30) or blood tests (13). Surveillance computerized tomography iden tified isolated asymptomatic intra-abdominal metastases in 10 patients (10% ), of whom 90% had pT3 disease. Based on these results we recommend a stage specific surveillance protocol for pT1-annual history, physical examinatio n, chest x-ray and laboratory studies, pT2-same studies at 6, 12, 18, 24, 3 0, 36, 48 and 60 months after cystectomy, and pT3-same studies at 3, 6, 12, 18, 24, 30, 36, 48 and 60 months plus computerized tomography at 6, 12 and 24 months after cystectomy. A radiographic study of the upper tract should be performed in all patients every 1 to 2 years to evaluate for recurrence s and complications of the ileoureteral anastomosis. Conclusions: A stage driven surveillance strategy for monitoring patients a fter radical cystectomy can reduce costly imaging studies while efficiently detecting recurrences and complications.