Surgical Resection Should Be Viewed With Skepticism in Patients With Bladder Cancer
Two centuries ago, Paget described the process of metastasis not as a random event but as a systemic disorder that is subject to laws (seed and soil theory) (1). Local therapeutic measures such as surgical resection of tumor metastases can have a curative intent only when the laws of the metastasis are known, or effective systemic therapy (for example, chemotherapy) is available, which restricts the surgical resection of metastases to minimal tumor residues. The prognosis is always poor when systemic therapy has no effect or not enough of an effect. This also applies to patients with testicular tumors and an otherwise excellent prognosis (2).
With regard to the importance of surgical resection of metastases in metastatic bladder cancer I wish to discuss one of the few prospective studies in 70 patients with metastatic bladder cancer that was refractory to chemotherapy (MVAC) (3). 19 out of the 70 patients had asymptomatic metastases, and 51/70 patients had symptomatic (multifocal) metastases. Only the patients with symptomatic metastases benefited in terms of quality of life. Improvements of the patients’ general condition was observed in 83% of patients (WHO criteria, 3.3 versus 2.1, P=0.005). Patients’ mean survival in the context of the prospective analysis, independently of symptoms, was 7 months and thus clearly different from the reported positive survival data from retrospective analyses and registry analyses (mean survival 38 months). The indication for such surgery should be reserved for selected individual cases. Quality of life should be the main consideration.
Prof. Dr. med. Thomas Otto
Urologische Klinik, Städtische Kliniken Neuss
Rheinisch Westfälisches Zentrum für Beckenchirurgie e. V.
Deutsches Zentrum zur Entwicklung und Prüfung
innovativer Techniken in der Medizin e.V.
Conflict of interest statement
The author declares that no conflict of interest exists.
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|2.||Wood DP, Herr HW, Motzer PR, Reuter V, Sogani PC, Morse MJ, Bosl GJ: Surgical resection of solitary metastases after chemotherapy in patients with non seminomatous germ cell tumors and elevated serum tumor markers. Cancer 1992; 60: 2354–7 CrossRef MEDLINE|
|3.||Otto T, Krege S, Suhr J, Rübben H: Impact of surgical resection of bladder cancer metastases refractory to systemic therapy on performance score—a phase II trial. Urology 2001; 57: 55–9 CrossRef MEDLINE|
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