ICUD-EAU International Consultation on Bladder Cancer 2012: Radical Cystectomy and Bladder Preservation for Muscle-Invasive Urothelial Carcinoma of the Bladder |
| |
| Authors: | Georgios Gakis Jason Efstathiou Seth P. Lerner Michael S. Cookson Kirk A. Keegan Khurshid A. Guru William U. Shipley Axel Heidenreich Mark P. Schoenberg Arthur I. Sagaloswky Mark S. Soloway Arnulf Stenzl |
| |
| Affiliation: | 1. Department of Urology, University Hospital Tuebingen, Tuebingen, Germany;2. Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA;3. Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA;4. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;5. Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA;6. Department of Urology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany;g The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA;h Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA;i Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA |
| |
| Abstract: | ContextNew guidelines of the International Consultation on Urological Diseases for the treatment of muscle-invasive bladder cancer (MIBC) have recently been published.ObjectiveTo provide a comprehensive overview of the current role of radical cystectomy (RC) in MIBC.Evidence acquisitionA detailed Medline analysis was performed for original articles addressing the role of RC with regard to indication, timing, surgical extent, perioperative morbidity, oncologic outcome, and follow-up. The analysis also included radiation-based bladder-preserving strategies.Evidence synthesisThe major findings are presented in an evidence-based fashion and are based on large retrospective unicenter and multicenter series with some prospective data.ConclusionsOpen RC is the standard treatment for locoregional control of MIBC. Delay of RC is associated with reduced cancer-specific survival. In males, standard RC includes the removal of the bladder, prostate, seminal vesicles, and distal ureters; in females, RC includes an anterior pelvic exenteration including the bladder, entire urethra and adjacent vagina, uterus, and distal ureters. A procedure sparing the urethra and the urethra-supplying autonomous nerves can be performed in case of a planned orthotopic neobladder. Further technical variations (ie, seminal-sparing or vaginal-sparing techniques) aimed at improving functional outcomes must be weighed against the risk of a positive margin. Laparoscopic surgery is promising, but long-term data are required prior to accepting it as an option equivalent to the open procedure. Lymphadenectomy should remove all lymphatic tissue around the common iliac, external iliac, internal iliac, and obturator region bilaterally. Complications after RC should be reported according to the modified Clavien grading system. In selected patients with MIBC, bladder-preserving therapy with cystectomy reserved for tumor recurrence represents a safe and effective alternative to immediate RC. |
| |
| Keywords: | Bladder cancer Radical cystectomy Bladder preservation Recommendations Guidelines |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
