1651 PALLIATIVE RADICAL CYSTECTOMY IN PATIENTS WITH METASTATIC BLADDER CANCER - WHAT IS IT WORTH?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease I1 Apr 20101651 PALLIATIVE RADICAL CYSTECTOMY IN PATIENTS WITH METASTATIC BLADDER CANCER - WHAT IS IT WORTH? Michael Rink, Sarah Minner, Oliver Balzer, Roland Dahlem, Stefan Balabanov, Hartwig Huland, Margit Fisch, and Felix Chun Michael RinkMichael Rink More articles by this author , Sarah MinnerSarah Minner More articles by this author , Oliver BalzerOliver Balzer More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Stefan BalabanovStefan Balabanov More articles by this author , Hartwig HulandHartwig Huland More articles by this author , Margit FischMargit Fisch More articles by this author , and Felix ChunFelix Chun More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1453AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Overall survival in patients with metastatic bladder cancer is limited ranging, in order to the metastatic site and chemotherapeutic treatment, between few months and years. Furthermore these patients often suffer from complications caused by the advanced tumour. Due to their short life expectancy most patients do not receive invasive surgical treatment. We investigated the status of palliative cystectomy in select patients with expected or known primary metastatic bladder cancer. METHODS Between 1996 and 2009, over 400 radical cystectomies (RCX) for treatment of advanced bladder cancer were performed in a single institution. A retrospective analysis of all data regarding patients with pN2 and M1-stage was performed. Statistical analysis controlling for surgical feasibility including operation time, blood loss, blood transfusion, and perioperative complications stratified by the modified Clavien system were performed. As a proxy of QoL, time summaries of hospitalization of all treatment procedures (including surgical and adjuvant therapy) until overall mortality were quantified. Last, overall and cancer specific survival were analysed. RESULTS Median overall survival (OS) was 8 month. 28 patients (48%) died cancer specific. Overall, 58 radical cystectomy patients had pN2 or M1 stage. Of these, 9 (15.5%) patients had M1 (group A) and 49 (84.5%) pN2 (group B) disease, respectively. Mean positive LN density was 43±29%. Median operation time, loss of blood and blood transfusions were 385 min., 1500ml and 3, respectively, without differences between both groups (p=n.s.). Incontinent urinary diversion was used for all patients with M1 and 53% of patientiens with pN2 disease. Postoperative complications occurred in 65% of all patients with major complications in 22%. Mean hospital duration after RCX and overall hospitalization time of all treatment procedures were 25±11 and 46±26 days (range: 12-63 and 15-148) without significant differences between both groups. Overall survival was equally worse in both groups (p=0.9). CONCLUSIONS Palliative cystectomy is feasible in select metastatic bladder cancer patients. However, the rate of early complications is high, overall survival is limited and hospitalization time adds up is about 1/5 of OS. Therefore, palliative cystectomy should be estimated carefully and alternative options have to be discussed with the patients. Hamburg, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e637-e638 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rink More articles by this author Sarah Minner More articles by this author Oliver Balzer More articles by this author Roland Dahlem More articles by this author Stefan Balabanov More articles by this author Hartwig Huland More articles by this author Margit Fisch More articles by this author Felix Chun More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...