title: Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05).
abstract: BACKGROUND
  Recent publications suggest a benefit from surgical removal of urothelial carcinoma metastases (UCM) for a subgroup of patients.
  
  
  OBJECTIVE
  We report the combined experience and outcome of patients undergoing resection of UCM gained at 15 uro-oncologic centers in Germany.
  
  
  METHODS
  Retrospective survey of 44 patients with distant UCM of the bladder or upper urinary tract who underwent complete resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008.
  
  
  METHODS
  Resected metastatic sites were the following: retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). Systemic chemotherapy was administered in 35 of 44 patients (79.5%) before and/or after UCM surgery.
  
  
  METHODS
  Overall, cancer-specific and progression-free survival from time of diagnosis and metastasectomy of UCM.
  
  
  CONCLUSIONS
  Median survival from initial diagnosis of UCM and subsequent resection was as follows: overall survival, 35 mo and 27 mo; cancer-specific survival, 38 mo and 34 mo; and progression-free survival, 19 mo and 15 mo. Overall 5-yr survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up of 8 mo. Seven patients without disease progression survived for >2 yr and remained free from tumor progression at a median follow-up of 63 mo. No significant prognostic factors could be determined due to the limited patient number.
  
  
  CONCLUSIONS
  Long-term cancer control and possible cure can be achieved in a subgroup of patients following surgical removal of UCM. Metastasectomy in patients with disseminated UCM remains investigational and should only be offered to those with limited disease as a combined-modality approach with systemic chemotherapy.
authors.affiliation: Department of Urology, Städtisches Krankenhaus Kiel, Kiel, Germany. lehmannkiel@arcor.de
authors.forename: Jan
authors.initials: J
authors.lastname: Lehmann
authors.forename: Henrik
authors.initials: H
authors.lastname: Suttmann
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.forename: Björn
authors.initials: B
authors.lastname: Volkmer
authors.forename: Jürgen E
authors.initials: JE
authors.lastname: Gschwend
authors.forename: Guido
authors.initials: G
authors.lastname: Fechner
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Axel
authors.initials: A
authors.lastname: Odenthal
authors.forename: Christoph
authors.initials: C
authors.lastname: Seif
authors.forename: Nils
authors.initials: N
authors.lastname: Nürnberg
authors.forename: Christian
authors.initials: C
authors.lastname: Wülfing
authors.forename: Christoph
authors.initials: C
authors.lastname: Greb
authors.forename: Tilmann
authors.initials: T
authors.lastname: Kälble
authors.forename: Marc-Oliver
authors.initials: MO
authors.lastname: Grimm
authors.forename: Claus Friedrich
authors.initials: CF
authors.lastname: Fieseler
authors.forename: Susanne
authors.initials: S
authors.lastname: Krege
authors.forename: Margitta
authors.initials: M
authors.lastname: Retz
authors.forename: Heiner
authors.initials: H
authors.lastname: Schulte-Baukloh
authors.forename: Martin
authors.initials: M
authors.lastname: Gerber
authors.forename: Markus
authors.initials: M
authors.lastname: Hack
authors.forename: Jörn
authors.initials: J
authors.lastname: Kamradt
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*