Surgically treated transitional cell carcinomas of the bladder. The role of radical surgery

OBJECTIVE: To assess the treatment outcome and differentiate between the individual behavior of the tumor stages that were studied (Ta, T1, and T2a) with special reference to T2a tumors.

METHODS: This study was carried out at Al-Rasheed Military Hospital, Baghdad, Iraq, during a 12 year period. Fifty-six patients with Ta, T1, and T2a (superficial invasion of muscularis propria) transitional cell carcinomas of the bladder, have been retrospectively analyzed. They were treated surgically with either transurethral of the bladder tumor (N=45) or radical surgery (N=11). Tumors with frequent recurrences or mulifocal or extending to the ureter or vesical outlet were treated with radical surgery. No adjuvant intraveiscal chemotherapy or bacillus calmette-guerin therapy was practiced.

RESULTS: All Ta tumors were controlled by transurethral of the bladder tumor treatment. Seventy-five percent of T1 tumors were controlled by transurethral of the bladder treatment and 25% qualified for radical surgery according to our criteria. Sixty percent of T2a tumors were controlled by transurethral of the bladder treatment and 40% warranted radical surgery. No stage progression occurred in Ta and T1 lesions, but 27% of T2a lesions (superficial invasion of muscularis propria) progressed to T2b (deep invasion of muscularis propria). All grade 2a lesions of all stages under study were controlled by transurethral of the bladder treatment. Of 6 patients with T2a grades 2b and 3 tumors, 5 patients (83%) qualified for radical surgery. No distant metastasis occurred during the observation period, which ranged from 4 months to 12 years (mean 51 months). Seventy-five percent of all patients, 78% of the transurethral of the bladder treatment group and 64% of the radical surgery group are alive and free of disease for 5 years or more.

CONCLUSION: Radical surgery is indicated for T1 and T2a bladder carcinomas if they were multifocal, or extending to the ureter or the vesical outlet or frequently recurring within the first year, specially if they were T1 tumors of grade 3 or T2a tumors of grades 2b and 3. Transurethral resection is justifiable for grades 1 and 2a, low risk T2a tumors.