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Radical cystectomy for primary bladder malignancy: a 10‐year review

Purpose:  Radical cystectomy has long been the gold standard in the definitive management of muscle invasive bladder cancer and preventing stage progression in high risk groups. There are few recent reviews outside of major international centres. We compared our institution's results to published literature.Methodology:  Records of 50 consecutive patients treated with radical cystectomy for biopsy proven bladder carcinoma between 1995 and 2005 were reviewed.Results:  The mean age was 70 years and 76% were male. Median follow up was 37 (1–111) months. 23 patients (46%) had known history of superficial TCC and 12 patients (24%) had previous intravesical therapy. Transitional cell tumours accounted for 94% of cases and most (76%) were poorly differentiated. 24 (48%) had ≥pT3 disease. Regional lymph nodes were involved in 35%. 23 patients (46%) developed recurrence and over half (12 patients) recurred within 12 months. Both lymph node involvement and recurrence were associated with higher pT stage (P < 0.001). All patients with recurrent disease were dead within a year (median 103 days). Median hospital stay was 19 days and there was 1 postoperative death (2%). 5‐year disease free and overall survival were 42% and 34% respectively.Conclusion:  Survival following curative resection for primary bladder malignancy is at best modest. Our overall proportion of higher staged disease contributed to poorer survival rates. An earlier more aggressive approach to definitive treatment may be warranted.