Long-term outcome of radical cystectomy in ESDR patients with bladder urothelial carcinoma

• Published in: International urology and nephrology 2011-12, Vol.43 (4), p.1067-1071
• Main Authors: Tseng, Shu-Fen, Chuang, Yao-Chi, Yang, Wen-Chou
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Transitional Cell - complications; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Cystectomy - adverse effects; Female; Humans; Kaplan-Meier Estimate; Kidney Failure, Chronic - complications; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Nephrectomy; Nephrology; Renal Dialysis - adverse effects; Retrospective Studies; Time Factors; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology; Urology – Original Paper
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-011-9960-7

Purpose The prevalence of urothelial carcinoma is high in dialysis patients. Radical cystectomy is an invasive procedure for patients with recurrent, multiple, or invasive bladder cancer. However, the prognosis of radical cystectomy in dialysis patients has rarely been reported. This study investigates the long-term outcome of radical cystectomy in dialysis patients with bladder urothelial carcinoma. Materials and methods Clinical data of 193 dialysis patients with bladder urothelial carcinoma were reviewed. Among them, 45 patients received radical cystectomy. Thirty-two patients who received radical cystectomy with concurrent nephroureterectomy were in a stable chronic dialysis condition. In contrast, we performed radical cystectomy without concurrent nephroureterectomy for patients ( N  = 13) at high surgical risk, such as tumors combined with infection, or hemodynamically unstable. Survival was evaluated using the Kaplan–Meier method. Results The overall survival rates were 86.7, 80.0, 62.2, 44.4, and 35.6% at 3-months, 6-months, 1-year, 3-years, and 5-years, respectively. Patients who received concurrent nephroureterectomy had a higher mortality rate (13%) than radical cystectomy alone (0.0%) under operative 3 months. However, the patients who received concurrent nephroureterectomy had a higher 5-year survival rate than the group without concurrent nephroureterectomy (43.7 vs. 15.4%). The causes of death included dialysis complications ( N  = 19, 42.1%), infection ( N  = 7, 36.8%), and disease metastasis ( N  = 4, 21.1%). Conclusion Dialysis patients in a stable chronic dialysis condition with recurrent or invasive bladder urothelial carcinoma could have survival benefits in receiving concurrent nephroureterectomy.