TURBT able to cure high risk recurrent superficial or muscle invasive bladder cancer : Factors resulting in pT 0 radical cystectomy specimens

ARTICLE INFO _________________________________________________________ ___________________ Vol. 39 (3): 364-370, May June, 2013 doi: 10.1590/S1677-5538.IBJU.2013.03.09 IBJU | factors for pt0 radical cystectomy 365 reported no survival advantage (6) most of them reported excellent long-term survival rates for patients with tumor downstaging (1,5,7-11). The inclusion of patients who have been treated with neoadjuvant chemotherapy (NAC) and/or radiotherapy (5,6,8,10) complicates the interpretation of the results of these studies. Our aim was to perform an analysis in our series (our center is a regional cancer center covering a population over 2 million) of radical cystectomies in order to determine which factors caused downstaging and particularly the absence of tumor at radical cystectomy. That obviously means that such tumors were in fact cured by just a TURBT from a surgical perspective. MATERIALS AND METHODS We retrospectively reviewed the final pathological result of all 51 radical cystectomies performed in our institution over the last 10 years (January 2002 until January 2012). Five pT0 radical cystectomies were discovered while patient and operative notes were thoroughly reviewed by two reviewers. Emphasis was placed when reviewing the notes on the initial TURBT pathology specimen, the surgeon who performed the TURBT and the details of the operation, whether any neo-adjuvant treatment (e.g. chemotherapy) was administered etc. Special attention was placed on the TURBT pathology specimen and thorough re-discussion with an uro-pathologist about all specimens was done. Factors that might have contributed to a pT0 cystectomy specimen were disclosed and a systematic review of the available literature (all articles in PubMed were searched including non-English publications using the keyword ‘pT0 radical cystectomy’) was performed in order to present possible factors leading to such favorable cystectomy specimens.