Indications and Oncologic Outcome of Radical Cystectomy for Urothelial Bladder Cancer†

ContextRadical cystectomy (RC) offers the best opportunity for ultimate cure of high-grade and high-risk invasive bladder cancer (BCa).ObjectiveTo review the available literature on indications for and oncologic outcomes of RC for urothelial carcinoma of the bladder.Evidence acquisitionA database search of the US National Library of Medicine (PubMed) was performed for relevant medical articles using the Medical Subject Headings invasive bladder cancer and radical cystectomy with restrictions to English-language publications.Evidence synthesisImmediate or early RC should be offered as a treatment of choice to all patients with recurrent or multifocal high-grade T1 tumours, T1 tumours at high risk of progression, failures of bacillus Calmette-Guérin treatment, and muscle-invasive bladder tumours. RC offers excellent recurrence-free survival (RFS) and disease-specific survival rates as well as local tumour control in patients with organ-confined and node-negative disease. Tumour control in non–organ-confined tumours is still satisfactory, with long-term RFS rates of about 50%. For node-positive disease, surgery may only be curative in approximately one-fourth of patients.ConclusionsEvidence from the literature supports early, aggressive surgical management for invasive BCa. Risk stratification of patients with BCa based on pathologic features at initial transurethral resection or at recurrence can select those patients most appropriate for RC early. In patients with organ-confined, lymph node–negative urothelial bladder carcinoma, excellent long-term survival rates can be achieved.