Practice patterns and recurrence after partial cystectomy for bladder cancer.
OBJECTIVE
Partial cystectomy (PC) remains a viable alternative to radical cystectomy (RC) for management of invasive bladder cancer in approximately 5% of patients. We used a population-based database to examine practice patterns and recurrence after partial cystectomy.


METHODS
We obtained billing records of all partial and radical cystectomies performed for bladder cancer in Quebec from 1983 until 2005. Analysis included age, gender, year of surgery, surgeon's age, hospital type, preoperative and postoperative visits with accompanying diagnoses and dates of recurrences salvage RC, and death.


RESULTS
A total of 714 (30.4%) patients with invasive bladder cancer underwent PC. Majority of PC (65%) were performed in non-academic institutions. Pelvic lymphadenectomy was performed in only 163 patients (23%) and concomitant ureteral reimplantation was performed in 89 patients (13%). Of 714 patients, 52 (23.7%) required a salvage RC. Median time from PC to salvage RC was 17.6 months (range 1-240 months), respectively. Patients who underwent PC had similar 5-year overall survival compared with patients who underwent upfront RC (49.8% vs. 51%, p = 0.21).


CONCLUSIONS
Rate of PC for invasive bladder cancer is significantly higher than expected. Pelvic lymphadenectomy is underutilized in bladder cancer patients treated with PC. Whether prevalent use of PC is due to less stringent selection criteria remains unknown. Since late recurrence is not uncommon, lifelong follow-up is recommended.
Fahmy
Nader
N
Department of Surgery (Urology), McGill University, Montreal, QC, Canada.
Aprikian
Armen
A
Tanguay
Simon
S
Mahmud
Salaheddin M
SM
Al-Otaibi
Mohammed
M
Jeyaganth
Suganthiny
S
Amin
Moamen
M
Kassouf
Wassim
W
D000368:Aged; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D015995:Prevalence; D011364:Professional Practice / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D016879:Salvage Therapy / Q000401:mortality; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*