Palliative cystectomy. Is there a place in bladder cancer surgery?

Introduction. DPatients diagnosed with T4b bladder cancer represent a relatively limited group of patients presenting to the urology clinic. Besides, this category of patients is rarely selected for cystectomy. patients with T4b should be referred for chemotherapy and/or radiation therapy and only later, ultimately, for cystectomy. However, there are currently no studies on the real impact of various organ invasions in terms of survival and complications associated with surgery in T4b patients. Also, in this subgroup of patients, cystectomy helps alleviate current or future symptoms of bladder cancer, and it is suggested that surgery after chemotherapy may improve survival compared to chemotherapy alone.

Purpose of the study. To evaluate the effectiveness of consolidating the surgery for bladder cancer cT4b, given the experience of cystectomy in terms of clinical and oncological results.

Materials and methods. The study included 29 patients with bladder cancer who underwent palliative cystectomy (pc) and 404 patients after radical cystectomy (RcE) with lymphadenectomy and various methods of urine diversion in the period 1995 - 2019. Palliative treatment was determined by the extreme stages of the oncological process (the presence of stage T4b).

Results. Preoperatively, the PC was planned to be performed in only 10 patients, whereas after the RCE it was palliative in 29 cases. According to our study, differences in the main treatment outcomes were not in favour of patients with PC. During the observation period, the overwhelming majority of patients — 24 of 29 (82.8%) died, while in the group after RCE, only 34.0% of patients died (p <0.05). No differences in the level of postoperative mortality were found (p >0.05). It was comparable with the data of modern literature in both cases (3.4% and 3.0%). This reflects the equal degree of safety of performing cystectomy in patients with bladder cancer at stage T4b in comparison with patients undergoing RCE, to a certain extent. The duration of the survivors' follow-up in the PC group ranges from 3 to 51 months with a median of 25.7 ± 13.9 months versus 73.9 ± 3.9 months in the RCE group in surviving patients (p <0.05) However, the analysis revealed that after 2 years in the group of patients who underwent PC more than 15% of survivors remain, which may indicate the possibility of using this type of treatment in patients with the last stage of bladder cancer.

Conclusion. Palliative cystectomy can be effective in a select group of patients with T4b bladder cancer with equal safety compared to RCE while maintaining the probability of life expectancy up to 48 months. It is important to develop and implement into practice new protocols of multimodal therapy for patients with pT4b bladder cancer to increase the life expectancy of patients and improve its quality.

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