title: Post-chemotherapy surgery in patients with unresectable or regionally metastatic bladder cancer.
abstract: OBJECTIVE
  We update our experience with post-chemotherapy surgery in patients with unresectable or lymph node positive bladder cancer.
  
  
  METHODS
  Of 207 patients with unresectable or regionally metastatic bladder cancer 80 (39%) underwent post-chemotherapy surgery after treatment with a cisplatin based chemotherapy regimen. We assessed the impact of surgery on achieving a complete response to chemotherapy and on relapse-free survival.
  
  
  RESULTS
  No viable cancer was present at post-chemotherapy surgery in 24 of the 80 cases (30%), pathologically confirming a complete response to chemotherapy. Of the 24 patients 14 (58%) survived 9 months to 5 years. Residual viable cancer was completely resected in 49 patients (61%), resulting in a complete response to chemotherapy plus surgery, and 20 (41%) survived. Post-chemotherapy surgery did not benefit those who failed to achieve a major complete or partial response to chemotherapy. Only 1 of the 12 patients (8%) who refused surgery remains alive.
  
  
  CONCLUSIONS
  Post-chemotherapy surgical resection of residual cancer may result in disease-free survival in some patients who would otherwise die of disease. Optimal candidates include those in whom the pre-chemotherapy sites of disease are restricted to the bladder and pelvis or regional lymph nodes, and who have a major response to chemotherapy.
authors.affiliation: Department of Urology and Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College, Cornell University, New York, New York, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Herr
authors.forename: S M
authors.initials: SM
authors.lastname: Donat
authors.forename: D F
authors.initials: DF
authors.lastname: Bajorin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*