Clinical and pathological studies on partial cystectomy for urinary bladder cancer. II. Examination on the reasonable extension of vesical wall resection with pathological procedure

Abstract

To clarify the reasonable extent of partial cystectomy, 48 specimens of vesical tumors obtained by partial cystectomy, and 25 specimens by total cystectomy were examined on the cell type and its infiltration sight as well as the histological aspect of vesical wall around the tumor, such as submucosal invasion, papillary hyperplasia, and Brunn's nest formation. And the following results were obtained.1) The transitional cell type was most frequent in its incidence, more than 80 per cent, while the squamous and the undifferentiated cell type were less frequent in bath the cases of partial and total cystectomy. Only one case of adenomatous cell type was found in the former case. As to the histological stage, the incidence of stage A, B1, B2, and C were 50.0, 29.2, 12.5, and 8. 3 per cent in the partially cystectomized cases. While in the case of total cystectomy, they were 28.0, 12.0, 24.0, and 36.0 per cent respectively. In the cases of recurrence of tumor, the transitional cell type was found in 60.0 per cent, and the squamous and the undifferentiated cell type were also seen in 30.0, and 10.0 per cent. As to the histological stage of these cases, the incidence of stage A, B1, and C were 30.0, 50.0, and 20.0 per cent respectively.2) In the specimens obtained by partial cystectomy, the submucosal invason of the tumor cell was found in 43.7 per cent at the part 1cm from the tumor, while it was seen in 18.7 per cent at the part 2cm from the tumor. The papillary hyperplasia was found in 50.0 per cent in the former part, while 18.7 per cent in the latter part, and there could be found significant difference between their incidence relating to the distance from the tumor. However, the Brunn's nest formation was found in 45.8 per cent and 34.4 per cent respectively, and there could not be found any marked difference in their incidence. On the other hand, the same examination was performed on the specimens obtained by total cystectomy, but almost the same results were obtained.With these results described above, as well as the sight of subumucosal invasion and papillary hyperplasia which are thought to have rather close relationship with the recurrence of the tumor, it should be pointed out that the resection of enough margin of the vesical wall around the tumor, more than 2cm should be desired, would be necessary for the partial cystectomy.3) In the case of partial cystectomy, the incidence of submucosal invasion at the part 1cm from the tumor was 25.0 per cent in stage A group, and 61.1-66.6 per cent in stage over B1, while it was 41.6 per cent at the part 2cm from the tumor of stage B1. In the case of total cystectomy, it was 66.6-83.3 per cent at the part 1cm from the tumor of stage over B1, while 77.7-83.3 per cent at the part 2cm from the tumor of stage over B2, and 25.0-50.0 per cent at the part 3cm from the tumor of stage over B2.With these results obtained above, it was clarified that the stage of the tumor was paralleled with the sight of submucosal invasion, however, any correlationship between the sight of invasion and the papillary hyperplasia or Brunn's nest formation could not be found. Therefore, it was assumed that the preoperative estimation upon the stage of the tumor would be very important to increase the clinical value of partial cystectomy for the bladder tumor, as well as the extension of the resection area if the stage might be rather high.4) Further histological examinations on the sight or submucosal invasion around the tumor were made according to Jewett's classification, but symbols such as a, b1, b2, and c were employed not to be confused with the histological stage of the tumor described above. And the following results were obtained. In the case of partial cystectomy, submucosal invasion of stage a was found in 71.4 per cent, stage b1 in 23.8 per cent and stage