The Road to Cystectomy: Who, When and Why?

Abstract

Objectives: Bladder cancer is the fifth most common solid malignancy amongst men in the western world. Around 30% of newly diagnosed patients will eventually die from the disease. Radical treatment with curative intent is the best option for patients with invasive bladder cancer. Cystectomy and urinary diversion represents a time-tested robust approach to treating this disease. Here we review the current indications for cystectomy and staging methods for transitional cell carcinoma (TCC). Methods: We conducted a search of the current literature to evaluate the evidence for the indications for cystectomy and the staging of TCC of the urinary bladder. Results: Radical cystectomy is usually performed for either invasive or high risk superficial bladder cancer. The outcome is dependent on the pathological stage of tumour at cystectomy. Whilst novel molecular staging methods are in development, current staging is by clinical, pathological and radiological methods. There is a recognised risk of either over- or under- staging the disease using current imaging techniques. Conclusion: The indications for radical cystectomy are changing with more emphasis on surgery for high-risk superficial disease. Better stratification of superficial disease has allowed the identification of such high risk cancers. It is likely that advances in molecular diagnosis and staging will come through to clinical practice in the near future.