title: Is there a role for surgery in the management of metastatic urothelial cancer? The M. D. Anderson experience.
abstract: OBJECTIVE
  Although rarely curative, chemotherapy remains the mainstay of treatment for metastatic urothelial cancer. The role of surgery for metastatic disease is not well established for urothelial cancer, but is sometimes undertaken in the face of persistent or recurrent disease that can be surgically resected.
  
  
  METHODS
  We identified 31 patients with metastatic urothelial cancer undergoing metastasectomy with the intent of rendering them free of disease. All gross disease was completely resected in 30 patients (97%). The most frequently resected location was lung in 24 cases (77%), followed by distant lymph nodes in 4 (13%), brain in 2 (7%) and a subcutaneous metastasis in 1 (3%).
  
  
  RESULTS
  Median survival from diagnosis of metastases and from time of metastasectomy was 31 and 23 months, respectively. The 5-year survival from metastasectomy was 33%. Median time to progression following metastasectomy was 7 months. Five patients were alive and free of disease for more than 3 years after metastasectomy.
  
  
  CONCLUSIONS
  The results in this highly selected cohort, with 33% alive at 5 years after metastasectomy, suggest that resection of metastatic disease is feasible and may contribute to long-term disease control especially when integrated with chemotherapy. Further prospective studies should be undertaken to better characterize the selection criteria and benefit from this intervention.
authors.affiliation: Center for Genitourinary Oncology and Department of Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, 77030-4009, USA. asiefker@mail.mdanderson.org
authors.forename: Arlene O
authors.initials: AO
authors.lastname: Siefker-Radtke
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Logothetis
authors.forename: Randall E
authors.initials: RE
authors.lastname: Millikan
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery