The rationale for radical cystectomy as primary therapy for T4 bladder cancer

Udo Nagele, Aristotelis G. Anastasiadis, Axel S. Merseburger, Stefan Corvin, Jörg Hennenlotter, Melanie Adam, Karl Dietrich Sievert, Arnulf Stenzl, Markus A. Kuczyk*

*Corresponding author for this work
22 Citations (Scopus)


Treatment of T4 bladder cancer patients remains a clinical challenge. Conservative management is often insufficient regarding local control, neoadjuvant chemotherapy delays definite treatment while leading to increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has also been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome, including therapy-related complications, in 20 T4 bladder cancer patients subjected to primary cystectomy. Twenty patients underwent radical cystectomy for T4 bladder cancer. At the time of surgery, 8 patients had regional lymph node metastases. The median postoperative follow-up was 13 months for the whole group. Mean duration of postoperative hospitalization was 19 days. Ten patients received no intra- or postoperative blood transfusions, whereas an average number of 3 blood units were administered in the remaining cases. Major therapy-associated complications were paresthesia affecting the lower extremities (n = 3) as well as insignificant pulmonary embolism, enterocutaneous fistulation and acute renal failure in one patient, respectively. At the time of data evaluation, 11 patients were still alive after a follow-up of 20 months. Four patients ≥70 years at the time of cystectomy were still alive after 11, 22 and 31 months following surgery, respectively. The current data demonstrate primary cystectomy for T4 bladder cancer as a technically feasible approach that is associated with a tolerable therapy-related morbidity. Additionally, satisfying clinical outcome is observed even in a substantial number of elderly patients.

Original languageEnglish
JournalWorld Journal of Urology
Issue number4
Pages (from-to)401-405
Number of pages5
Publication statusPublished - 08.2007

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)


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