P.G. Yakovlev, D.A. Klyushin, A.V. Sakalo

Which bladder sparing surgery is better when performing trimodal treatment of high-grade muscle invasive bladder cancer?

Trimodal treatment (TMT) is considered an alternative to radical cystectomy in selected patients with muscle-invasive bladder cancer. This includes resection of the bladder, radiotherapy to the pelvis, and concomitant chemotherapy. Key to success of organ-sparing approach and high cancer-specific survival is performance of maximal resection of the cancer in the bladder. Transurethral resection of the bladder cancer (TURB) as main element of TMT is known as a surgery with high risk of local recurrence.

Purpose of this work: is to compare the frequency of local recurrence and recurrence-free survival (RFS) of patients with high-grade bladder cancer (HGBC) after bladder-sparing surgeries: TURB and partial cystectomy (PCE).

Materials and methods. We retrospectively analyzed medical records of 409 patients with HGBC who underwent radical bladder sparing surgery (either TURB or PCE) in 1998-2016. RFS was analyzed with Kaplan-Meier method. Test of equality of two survival functions for TURB and PCE was performed with three statistical tools (log-rank, Wilcoxon, Tarone-Ware) at significance level of 0.05.

Results. TURB was done on 281 patients, PCE - 128 patients. Recurrences were diagnosed after 64 (15,6%) surgeries. After PCE the HGBC recurred more often than after TURB, 28 cases (after 21.9% PCE), vs. 36 cases (after 12.8% TURB) respectively. Median time to recurrence after PCE was 888 days, and 543 days after TURB. There was no statistically significant difference in RFS after two types of bladder sparing surgeries (р=0.195). Results of RFS after 1, 2 and 5 years after TURB and PCE were 47%, 22% та 6%, versus 54%, 36% та 18%, respectively.

Conclusions. Local recurrences of HGBC after organ-preserving surgeries were diagnosed in 15.6% patients, and were more frequent after partial cystectomy (21.9% of cases), than after transurethral resection (12.8%). Median time to recurrence was 888 days after PCE, and 543 days after TURB, but RFS was not statistically different between these two surgeries (р=0.195).