Skip to main content
Erschienen in: Die Urologie 11/2021

14.10.2021 | Harnblasenkarzinom | Leitthema

Indikationen und Technik der Frühzystektomie

verfasst von: Prof. Dr. F. Roghmann, R. Mayr, K. Tully, S. Engelmann, M. Burger, J. Noldus

Erschienen in: Die Urologie | Ausgabe 11/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die frühe radikale Zystektomie (RZE) ist eine Therapieoption beim nicht-metastasierten nicht-muskelinvasiven Urothelkarzinom der Harnblase (NMIBC). Nach früher RZE liegt die 15-Jahres-Gesamtüberlebensrate bei ungefähr 70 %. Allerdings ist die Operation mit einer relevanten Morbidität und Mortalität assoziiert, so dass eine sorgfältige Indikationsstellung erfolgen sollte. Im Rahmen der vorliegenden Arbeit soll die Indikationsstellung zur frühen RZE beleuchtet werden. Es wurde eine PubMed- und Leitlinienrecherche durchgeführt. Besonderes Augenmerk wurde auf den aktuellen EAU-Risikokalkulator (European Association of Urology) gerichtet. Mit ihm kann eine Identifikation der Patientengruppe mit sehr hohem Progressionsrisiko durchgeführt werden. Des Weiteren wird die Technik der frühen RZE betrachtet.
Literatur
1.
Zurück zum Zitat AWMF (2020) S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms. AWMF-Registernummer: 032/038OL. Langversion 2.0 AWMF (2020) S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms. AWMF-Registernummer: 032/038OL. Langversion 2.0
2.
Zurück zum Zitat Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J et al (2019) European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)—2019 update. Eur Urol 76(5):639–657CrossRef Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J et al (2019) European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)—2019 update. Eur Urol 76(5):639–657CrossRef
3.
Zurück zum Zitat Herr HW, Sogani PC (2001) Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol 166(4):1296–1299CrossRef Herr HW, Sogani PC (2001) Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol 166(4):1296–1299CrossRef
4.
Zurück zum Zitat Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–174CrossRef Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–174CrossRef
5.
Zurück zum Zitat Roghmann F, Trinh Q‑D, Braun K, von Bodman C, Brock M, Noldus J et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149CrossRef Roghmann F, Trinh Q‑D, Braun K, von Bodman C, Brock M, Noldus J et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149CrossRef
6.
Zurück zum Zitat Aziz A, May M, Burger M, Palisaar R‑J, Trinh Q‑D, Fritsche H‑M et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66(1):156–163CrossRef Aziz A, May M, Burger M, Palisaar R‑J, Trinh Q‑D, Fritsche H‑M et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66(1):156–163CrossRef
7.
Zurück zum Zitat May M, Bastian PJ, Brookman-May S, Burger M, Bolenz C, Trojan L et al (2011) Pathological upstaging detected in radical cystectomy procedures is associated with a significantly worse tumour-specific survival rate for patients with clinical T1 urothelial carcinoma of the urinary bladder. Scand J Urol Nephrol 45(4):251–257CrossRef May M, Bastian PJ, Brookman-May S, Burger M, Bolenz C, Trojan L et al (2011) Pathological upstaging detected in radical cystectomy procedures is associated with a significantly worse tumour-specific survival rate for patients with clinical T1 urothelial carcinoma of the urinary bladder. Scand J Urol Nephrol 45(4):251–257CrossRef
8.
Zurück zum Zitat Krajewski W, Zdrojowy R, Dembowski J, Poletajew S, Wróbel M, Łuczak M et al (2019) The optimal timing of restaging resection before introduction of bacillus calmette-guerin immunotherapy in patients with high-risk non-muscle-invasive bladder cancer. Urol Int 102(1):60–68CrossRef Krajewski W, Zdrojowy R, Dembowski J, Poletajew S, Wróbel M, Łuczak M et al (2019) The optimal timing of restaging resection before introduction of bacillus calmette-guerin immunotherapy in patients with high-risk non-muscle-invasive bladder cancer. Urol Int 102(1):60–68CrossRef
9.
Zurück zum Zitat Cambier S, Sylvester RJ, Collette L, Gontero P, Brausi MA, Van Andel G et al (2016) EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1–3 years of maintenance bacillus Calmette-Guérin. Eur Urol 69(1):60–69CrossRef Cambier S, Sylvester RJ, Collette L, Gontero P, Brausi MA, Van Andel G et al (2016) EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1–3 years of maintenance bacillus Calmette-Guérin. Eur Urol 69(1):60–69CrossRef
10.
Zurück zum Zitat Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Piñeiro L, Gonzalez M et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol 182(5):2195–2203CrossRef Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Piñeiro L, Gonzalez M et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol 182(5):2195–2203CrossRef
11.
Zurück zum Zitat Sylvester RJ, Van Der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49(3):466–475 (discussion 475-477)CrossRef Sylvester RJ, Van Der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49(3):466–475 (discussion 475-477)CrossRef
12.
Zurück zum Zitat Sylvester RJ, Rodríguez O, Hernández V, Turturica D, Bauerová L, Bruins HM et al (2021) European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) incorporating the WHO 2004/2016 and WHO 1973 classification systems for grade: an update from the EAU NMIBC guidelines panel. Eur Urol 79(4):480–488CrossRef Sylvester RJ, Rodríguez O, Hernández V, Turturica D, Bauerová L, Bruins HM et al (2021) European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) incorporating the WHO 2004/2016 and WHO 1973 classification systems for grade: an update from the EAU NMIBC guidelines panel. Eur Urol 79(4):480–488CrossRef
13.
Zurück zum Zitat Hentschel AE, van Rhijn BWG, Bründl J, Compérat EM, Plass K, Rodríguez O et al (2020) Papillary urothelial neoplasm of low malignant potential (PUN-LMP): still a meaningful histo-pathological grade category for Ta, noninvasive bladder tumors in 2019? Urol Oncol 38(5):440–448CrossRef Hentschel AE, van Rhijn BWG, Bründl J, Compérat EM, Plass K, Rodríguez O et al (2020) Papillary urothelial neoplasm of low malignant potential (PUN-LMP): still a meaningful histo-pathological grade category for Ta, noninvasive bladder tumors in 2019? Urol Oncol 38(5):440–448CrossRef
14.
Zurück zum Zitat Moschini M, Sharma V, Dell’Oglio P, Cucchiara V, Gandaglia G, Cantiello F et al (2016) Comparing long-term outcomes of primary and progressive carcinoma invading bladder muscle after radical cystectomy. BJU Int 117(4):604–610CrossRef Moschini M, Sharma V, Dell’Oglio P, Cucchiara V, Gandaglia G, Cantiello F et al (2016) Comparing long-term outcomes of primary and progressive carcinoma invading bladder muscle after radical cystectomy. BJU Int 117(4):604–610CrossRef
15.
Zurück zum Zitat Weizer AZ, Wasco MJ, Wang R, Daignault S, Lee CT, Shah RB (2009) Multiple adverse histological features increase the odds of under staging T1 bladder cancer. J Urol 182(1):59–65CrossRef Weizer AZ, Wasco MJ, Wang R, Daignault S, Lee CT, Shah RB (2009) Multiple adverse histological features increase the odds of under staging T1 bladder cancer. J Urol 182(1):59–65CrossRef
16.
Zurück zum Zitat Willis DL, Fernandez MI, Dickstein RJ, Parikh S, Shah JB, Pisters LL et al (2015) Clinical outcomes of cT1 micropapillary bladder cancer. J Urol 193(4):1129–1134CrossRef Willis DL, Fernandez MI, Dickstein RJ, Parikh S, Shah JB, Pisters LL et al (2015) Clinical outcomes of cT1 micropapillary bladder cancer. J Urol 193(4):1129–1134CrossRef
17.
Zurück zum Zitat Witjes JA, Babjuk M, Bellmunt J, Maxim Bruins H, De Reijke TM, De Santis M et al (2020) EAU-ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multistakeholder effort†: under the auspices of the EAU-ESMO guidelines committees. Eur Urol 77(2):223–250CrossRef Witjes JA, Babjuk M, Bellmunt J, Maxim Bruins H, De Reijke TM, De Santis M et al (2020) EAU-ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multistakeholder effort: under the auspices of the EAU-ESMO guidelines committees. Eur Urol 77(2):223–250CrossRef
18.
Zurück zum Zitat Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH (2014) Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: a systematic review and meta-analysis. Urol Oncol 32(8):1191–1199CrossRef Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH (2014) Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: a systematic review and meta-analysis. Urol Oncol 32(8):1191–1199CrossRef
19.
Zurück zum Zitat Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J (2015) Improving selection criteria for early cystectomy in high-grade T1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 33(6):643–650CrossRef Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J (2015) Improving selection criteria for early cystectomy in high-grade T1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 33(6):643–650CrossRef
20.
Zurück zum Zitat Voskuilen CS, Seiler R, Rink M, Poyet C, Noon AP, Roghmann F et al (2020) Urothelial carcinoma in bladder diverticula: a multicenter analysis of characteristics and clinical outcomes. Eur Urol Focus 6(6):1226–1232CrossRef Voskuilen CS, Seiler R, Rink M, Poyet C, Noon AP, Roghmann F et al (2020) Urothelial carcinoma in bladder diverticula: a multicenter analysis of characteristics and clinical outcomes. Eur Urol Focus 6(6):1226–1232CrossRef
21.
Zurück zum Zitat Lamm DL (1992) Carcinoma in situ. Urol Clin North Am 19(3):499–508PubMed Lamm DL (1992) Carcinoma in situ. Urol Clin North Am 19(3):499–508PubMed
22.
Zurück zum Zitat Griffiths TRL, Charlton M, Neal DE, Powell PH (2002) Treatment of carcinoma in situ with intravesical bacillus Calmette-Guerin without maintenance. J Urol 167(6):2408–2412CrossRef Griffiths TRL, Charlton M, Neal DE, Powell PH (2002) Treatment of carcinoma in situ with intravesical bacillus Calmette-Guerin without maintenance. J Urol 167(6):2408–2412CrossRef
23.
Zurück zum Zitat Palou J, Sylvester RJ, Faba OR, Parada R, Peña JA, Algaba F et al (2012) Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Guérin. Eur Urol 62(1):118–125CrossRef Palou J, Sylvester RJ, Faba OR, Parada R, Peña JA, Algaba F et al (2012) Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Guérin. Eur Urol 62(1):118–125CrossRef
24.
Zurück zum Zitat Solsona E, Iborra I, Dumont R, Rubio-Briones J, Casanova J, Almenar S (2000) The 3‑month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol 164(3 Pt 1):685–689CrossRef Solsona E, Iborra I, Dumont R, Rubio-Briones J, Casanova J, Almenar S (2000) The 3‑month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol 164(3 Pt 1):685–689CrossRef
25.
Zurück zum Zitat Food and Drug Administration (2018) BCG-unresponsive nonmuscle invasive bladder cancer: developing drugs and biologics for treatment guidance for industry. Center for Drug Evaluation and Research Food and Drug Administration (2018) BCG-unresponsive nonmuscle invasive bladder cancer: developing drugs and biologics for treatment guidance for industry. Center for Drug Evaluation and Research
26.
Zurück zum Zitat Roghmann F, Breyer J, Kriegmair M, Wezel F, Burger M, Noldus J et al (2021) Quality assessment of radical cystectomy—opportunities, risks, challenges. Urologe A 60(2):151–161CrossRef Roghmann F, Breyer J, Kriegmair M, Wezel F, Burger M, Noldus J et al (2021) Quality assessment of radical cystectomy—opportunities, risks, challenges. Urologe A 60(2):151–161CrossRef
27.
Zurück zum Zitat Russell B, Liedberg F, Khan MS, Nair R, Thurairaja R, Malde S et al (2020) A systematic review and meta-analysis of delay in radical cystectomy and the effect on survival in bladder cancer patients. Eur Urol Oncol 3(2):239–249CrossRef Russell B, Liedberg F, Khan MS, Nair R, Thurairaja R, Malde S et al (2020) A systematic review and meta-analysis of delay in radical cystectomy and the effect on survival in bladder cancer patients. Eur Urol Oncol 3(2):239–249CrossRef
28.
Zurück zum Zitat Via KJ, Burns KM, Lamm DL (2010) Tumor implantation: a rare but potentially preventable cause of death in cystectomy patients. Can J Urol 17(3):5216–5218PubMed Via KJ, Burns KM, Lamm DL (2010) Tumor implantation: a rare but potentially preventable cause of death in cystectomy patients. Can J Urol 17(3):5216–5218PubMed
29.
Zurück zum Zitat Satkunasivam R, Hu B, Metcalfe C, Ghodoussipour SB, Aron M, Cai J et al (2016) Utility and significance of ureteric frozen section analysis during radical cystectomy. BJU Int 117(3):463–468CrossRef Satkunasivam R, Hu B, Metcalfe C, Ghodoussipour SB, Aron M, Cai J et al (2016) Utility and significance of ureteric frozen section analysis during radical cystectomy. BJU Int 117(3):463–468CrossRef
30.
Zurück zum Zitat Hoang AN, Agarwal PK, Walton-Diaz A, Wood CG, Metwalli AR, Kassouf W et al (2014) Clinical significance of ureteric “skip lesions” at the time of radical cystectomy: the M.D. Anderson experience and literature review. BJU Int 113(5 B):E28–E33CrossRef Hoang AN, Agarwal PK, Walton-Diaz A, Wood CG, Metwalli AR, Kassouf W et al (2014) Clinical significance of ureteric “skip lesions” at the time of radical cystectomy: the M.D. Anderson experience and literature review. BJU Int 113(5 B):E28–E33CrossRef
31.
Zurück zum Zitat Witjes JA, Bruins HM, Cathomas R, Compérat EM, Cowan NC, Gakis G et al (2021) European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur Urol 79(1):82–104CrossRef Witjes JA, Bruins HM, Cathomas R, Compérat EM, Cowan NC, Gakis G et al (2021) European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur Urol 79(1):82–104CrossRef
32.
Zurück zum Zitat Wessels F, Lenhart M, Kowalewski KF, Braun V, Terboven T, Roghmann F et al (2020) Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World J Urol 38(12):3139–3153CrossRef Wessels F, Lenhart M, Kowalewski KF, Braun V, Terboven T, Roghmann F et al (2020) Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World J Urol 38(12):3139–3153CrossRef
33.
Zurück zum Zitat MacLennan GT, Kirkali Z, Cheng L (2007) Histologic grading of noninvasive papillary urothelial neoplasms. Eur Urol 51(4):889–897 (discussion 897-898)CrossRef MacLennan GT, Kirkali Z, Cheng L (2007) Histologic grading of noninvasive papillary urothelial neoplasms. Eur Urol 51(4):889–897 (discussion 897-898)CrossRef
Metadaten
Titel
Indikationen und Technik der Frühzystektomie
verfasst von
Prof. Dr. F. Roghmann
R. Mayr
K. Tully
S. Engelmann
M. Burger
J. Noldus
Publikationsdatum
14.10.2021
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 11/2021
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-021-01682-7

Weitere Artikel der Ausgabe 11/2021

Die Urologie 11/2021 Zur Ausgabe

GeSRU

GeSRU

AUO

AUO

Termine

Termine

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.