Surgical Approaches in Patients with Metastatic Bladder Cancer: Metastasectomy and Palliative Cystectomy


  • Utku Lokman
  • Özgür Uğurlu

Bull Urooncol 2014;13(2):75-78

Bladder cancer is the second most frequently diagnosed genitourinary malignancy and muscle-invasive bladder cancer accounts for 30% of the cases. 20% of muscle-invasive bladder cancer patients have metastatic or unresectable disease, which is primarily treated with systemic chemotherapy. Patients, who have non-metastatic and resectable disease, are directed to radical cystectomy; however, half of them progress, postoperatively, to metastatic disease. In this group primary treatment option is also systemic chemotherapy. Overall survival rates are increased after routine usage of modern chemotherapy protocols, but response rates to chemotherapy are not more than 50-70%. Median overall survival rate is around 13-14 months, which was below the 3-6 months before these chemotherapy regimens. Alternative treatment options, such as radiotherapy and surgery, are discussed in non-responsive patients to chemotherapy. These treatment options are also discussed in partial responsive patients, due to residuel tumors. Complete responsive patients have also come up with relapses, which generally arise from the previous site of disease, thus need secondary treatment. Even though vinflunine seems to be an effective second-line chemotherapeutic drug, it is shown that post-chemotherapy surgery can increase overall survival up to 2-3 times than expected, especially in paitents who have limited metastatic disease and respond to chemotherapy. Post-chemotherapy surgery can also increase the quality of life in symptomatic patients. Palliative cystectomy is a last-choice treatment option in patients who have persistant hematuria, severe pain and irritative voiding symptoms. (Bulletin of Urooncology 2014;13:75-78)

Keywords: Metastatic bladder cancer, metastasectomy, palliative cystectomy