Study of survival after cystectomy for bladder cancer in a series of 504 cases.

Objectives: Cystectomy is the reference treatment for invasive bladder canc er and superficial tumours with a high risk of recurrence. However the long -term results of this treatment remain controversial. Progress in anaesthes ia-intensive care and surgical techniques appear to have improved the progn osis of this disease over the last two decades. The availability of numerou s adjuvant therapies (radiotherapy and chemotherapy) and the development of alternative conservative management therefore require a re-evaluation of t he long-term results of cystectomy for bladder cancer performed over the la st 20 years. Material and Methods: The case files of 504 consecutive patients undergoing cystectomy for bladder cancer in our department from 1981 to 1997 were rev iewed The operative and postoperative morbidity and actuarial survival by s tage were studied Histological prognostic factors and the influence of adju vant therapies were also studied. Results: According to the TNM 97 classification, 55% of tumours (on the cys tectomy specimen) were intravesical (< T3), and 70% of patients had negativ e lymph nodes (N0). The perioperative mortality was 1.56%. The overall surv ival at 2 years 5 years and 10 years for the total patient population was 8 3.1%, 52.3% and 46.6%. respectively. The 5-year snrvil al of tumours confin ed to the bladder (< T3) was 79.4% versus 27.5% when the tumour extended be yond the bladder (> T3). The lymph node status considerably influenced surv ival. N0, N1 and N2-3 patients had 5-year survival rates of 64%, 48% and 14 %, respectively Neoadjuvant chemotherapy or radiotherapy did not appear to improve survival. Conclusions: Survival after cystectomy for bladder cancer essentially depen ds on pathological stage and lymph node status. Patients with a localized t umour have a 5-year survival greater than 80%. Prospective studies are requ ired to determine the real benefit of adjuvant chemotherapy, as its value h as not yet been formally demonstrated.