Total Cystectomy for Carcinoma of the Bladder

Abstract

A series of 50 patients treated with total cystectomy for transitional cell carcinoma is reported. The cases are grouped according to the histologic type and stage of the carcinoma. Forty-three patients had anaplastic carcinomas, of which 32 had invaded more than half of the bladder musculature (Stages P3 and P4). Twelve patients came to operation despite the presence of recognised distant metastases. Nine primary deaths occurred among 38 patients treated with radical surgery. When five years had elapsed, 8 of 29 patients were alive (28 per cent), of whom one had a recurrence in loco. The conclusion is drawn that cystectomy is best suited to tumours which have invaded to a depth of more than half the bladder musculature, or those with perivesical infiltration (Stage P3). However, the results hitherto recorded with supervoltage radiation are somewhat better than those obtained with cystectomy. The problems attached to urinary diversion following total cystectomy are considered briefly. Uretero-ileo-cutaneostomy according to Bricker is recommended.