What Is Radical Cystectomy (Bladder Removal Surgery)? To Whom It Can Be Performed?
We can define Radical Cystectomy as a surgical procedure in which bladder is removed. This surgery is performed to the patients who have progressed and/or high risk bladder cancer. In men, we remove the bladder together with prostate, seminal vesicles and the lymph nodes. In women, we remove uterus, ovaries, a part of the vagina and surrounding lymph nodes together with the bladder. If the bladder tumor invades the muscle wall of the bladder which we call t2 stage cancer, radical cystectomy surgery is our first choice for the treatment.
We may use intravenous chemotherapy before the surgery to increase the chance of the curement or after the surgery to kill the remaining cells seen in pathological evaluation. Despite using chemotherapy before or after surgery, we still may not reach to the expected result. This situation brings out the question: is t2 stage late for the curement of the bladder cancer?
Recently, American Urology Association and European Urology Association set a research group over 5000 patients. In order to obtain better solutions, the surgeons decided to perform radical cystectomy surgery to t1 stage bladder cancer group. T1 stage is the stage where the tumor is confined to inner layers, not spread to the muscles of bladder wall. The results were so successfull that the surgeons attending the research agreed on the decison to perform the radical cystectomy to the patients with t1 stage bladder cancer.
Which Patients with T1 Stage Bladder Cancer Can Be Canditate For Radical Cystectomy To Accomplish The Best Curement?
- Pathological parameters of the patients who underwent turbt (transurethral resection of bladder tumor) are very important for us to determine the radical cystectomy in t1 stage.
- If the pathology report mentions t1 stage with many or one larger than 3 cm with LVI( +) and CIS ( +) we shouldn’t waıt for t2 stage to perform radical cystectomy.
- When viable tumor tissue is observed during the routine biopsy at first follow-up after bcg, we decide for urgent removal of bladder for the bcg-unresponsive patient and do not wait for t2 stage.
- When t1 stage patient who underwent bcg treatment but can not use bcg due to its side effects, bladder removal is needed urgently so we don’t wait for t2 stage.
- When the pathologıcal evaluation after turbt shows that there is a rarely seen bladder tumor instead of expected usually seen one, there is urgent need for romoval of the bladder so we don’t wait for t2 stage.
What Are The Rarely Seen Bladder Tumors?
- *MICROPILLAR UROTHELIAL CARCINOMA
- *SQUAMOUS OR GLANDULAR OR TROPHOBLASTIC UROTHELIAL CARCINOMA
- *NESTED VARIANT MICROCYSTIC UROTHELIAL CARCINOMA
- *SARCOMATOID UROTHELIAL CARCINOMA
- PLASMOCYTOID, GIANT CELL, SIGNET RING, LENFOEPİTELYOMA
- SMALL CELL
Who should undergo Radical Cystectomy Surgery?