Clinical analysis of partial cystectomy combined with chemotherapy in treating localized muscle invasive bladder cancer (a report of 53 cases)

Abstract

Objective To evaluate the safety and effectiveness of partial cystectomy combined with chemotherapy in treating localized muscle invasive bladder cancer. Methods The patients admitted to localized muscle invasive bladder cancer from October 2011 to December 2015 were screened according to the strict inclusion criteria, and the final 53 patients were enrolled in the study, 37 males and 16 females, aged 36 to 85 (63.72±13.31)years. Tumor diameter 1.5-4.0 (2.52±0.56)cm, the number of ≤ 3 and the edge of the tumor from the ureteral opening >2 cm. All pathological types are urothelial carcinoma. All patients were examined by MRI clinical stage T2a-T2b period. A total of 53 patients with muscle invasive bladder cancer who refuse or older, merge the heavier medical disease, difficult to tolerate radical cystectomy.Using partial cystectomy, intraoperative electrosurgical excision to deep muscle, parallel to the tumor bed frozen to confirm negative margins, postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of hydroxycamptothecin. Results Patients were successfully op-erated, and no margin positive or incision planting cases. The operating time is 55-110 min and average (79.11±17.25)min.There was no serious complication in operation and postoperative, pathological diagnosis was invasive epithelial cell carcinoma of the urinary tract, pathology classification: low level 41 cases, and high level 12 cases. Follow up of 12 to 62 months, an average of (27.11±12.22)months, 21 cases of recurrence, 12 patients had superficial recurrence in the bladder who was treated successfully by transurethral resection of bladder tumor, 5 cases of multiple myometrial invasion who was treated by radical cystectomy (3 cases died of bladder cancer after the surgery in 8, 12, and 18 months later), 4 cases of myometrial invasion with recurrence of pelvic lymph node metastasis or even distant metastasis to give up treatment (all died within six months of bladder cancer). The first tumor recurrence time 3-18 months, 11 months and the median time. Conclusions Our data indicate that partial cystectomy combined with chemotherapy is a safe and effective in treating localized muscle invasive bladder cancer, with less trauma, shorter operative time and higher safety, so as to provide an alternative treatment for patients with advanced age, high risk or who can not be implemented transurethral resection of bladder tumor or who refused to undergo radical cystectomy. Key words: Cystectomy; Drug therapy; Urinary bladder neoplasms/TH