Organ Preservation for Muscle-Invasive Bladder Cancer by Transurethral Resection

Objectives: To determine the feasibility of bladder preservation using transurethral resection for patients with muscle-invasive cancer and to determine the proportion of patients with muscle-invasive disease who would be eligible for this approach. Methods: A retrospective review demonstrated that 327 patients with muscle-invasive bladder cancer were treated in our institution from 1997 to 2002. Resection was repeated in all patients, and bladder preservation was offered to patients with no residual tumor, normal examination findings under anesthesia, and normal upper urinary tract findings. Patients were followed up by routine cystoscopy for a median of 2.45 years. The study endpoints included overall and disease-specific survival rates, the need for additional systemic chemotherapy, and cystectomy-free survival. Results: Of 327 patients, 35 (11%) were eligible for bladder preservation; 27 elected to pursue this approach and 8 opted for immediate cystectomy. Of the 27 patients, 15 experienced subsequent tumor recurrence, 8 of whom underwent radical cystectomy. Thus, the bladder was preserved in 19 (70%) of the 27 patients. Of the patients who underwent cystectomy, 5 also received chemotherapy. Five patients died, including three of unrelated diseases, one of metastatic cancer, and one of surgical complications. The overall and disease-specific survival rate was 81% and 93%, respectively. Conclusions: Bladder preservation using transurethral resection is feasible in selected patients. Only a small proportion of patients with muscle-invasive bladder cancer, however, are candidates for this approach.