Partial Cystectomy for Muscle Invasive Urothelial Carcinoma of the Bladder: A Contemporary Review of the M. D. Anderson Cancer Center Experience Wassim Kassouf, David Swanson,* Ashish M. Kamat,† Dan Leibovici, Arlene Siefker-Radtke, Mark F. Munsell, H. Barton Grossman‡ and Colin P. N. Dinney§, From the Departments of Urology (WK, DS, AMK, DL, HBG, CPND), Medical Oncology (ASR), and Biostatistics and Applied Mathematics (MFM), The University of Texas M. D. Anderson Cancer Center, Houston, Texas Purpose: Partial cystectomy is a surgical option for select patients diagnosed with urothelial carcinoma. We review our experience with partial cystectomy for muscle invasive urothelial carcinoma to assess local control and survival rates. Material and Methods: From 1982 to 2003 a total of 37 patients with muscle invasive urothelial carcinoma underwent partial cystectomy with curative intent. Reviewed data included history of superficial tumors, presence of variant histology, tumor location, clinical stage, pathological stage, presence of carcinoma in situ, adjuvant therapy and disease status. Results: The 5-year overall, disease specific and recurrence-free survival rates were 67%, 87% and 39%, respectively. Mean followup was 72.6 months (range 6 to 217). Of the 37 patients 19 (51%) did not have tumor recurrence, 9 (24%) had superficial recurrence in the bladder that was treated successfully and 9 (24%) had recurrence with advanced disease. A total of 24 patients (65%) had an intact bladder with no evidence of disease after a median of 53 months. There were 6 patients (16%) who died of bladder cancer, 3 of whom died of late recurrence of muscle invasive cancer (41, 44 and 138 months after partial cystectomy). On multivariate analysis higher pathological stage (HR 3.4, p = 0.04) was associated with shorter recurrence- free survival. A history of superficial tumors (p 0.01) and clinical stage (p = 0.01) was associated with advanced recurrence-free survival. The use of adjuvant chemotherapy (HR 0.18, p = 0.03) was associated with prolonged advanced recurrence-free survival, however adjuvant chemotherapy did not impact overall survival. Conclusions: Partial cystectomy provides adequate local control of muscle invasive bladder cancer in select patients. Because late recurrence is not uncommon and is potentially life threatening, lifelong followup with cystoscopy is recom- mended. Key Words: carcinoma, transitional cell; cystectomy; recurrence P artial cystectomy is a bladder preserving procedure that allows full thickness, wide surgical excision of the portion of bladder and overlying peritoneum containing the malignancy. Partial cystectomy for muscle invasive urothelial carcinoma was popularized in the 1950s but subsequently lost favor because of the unaccept- ably high rates of recurrent bladder cancer (40% to 78%), which were caused in large part to suboptimal selection criteria for this procedure. 1–3 Furthermore, the establish- ment of continent urinary diversions and the realization of nerve sparing and prostate sparing cystectomy have de-emphasized the selection of partial cystectomy as an oncological, organ preserving procedure. Nevertheless, in properly selected patients partial cystectomy is an attrac- tive option because it permits accurate staging by lymph- adenectomy, complete tumor excision with wide surgical margins, and adequate bladder and sexual function. The ideal patients are those with a functional bladder and a solitary, primary tumor in the dome or posterolateral wall of the bladder that can be resected with a reasonable margin without the need for ureteral reimplantation. Par- tial cystectomy can be performed after systemic chemo- therapy and can be used to manage invasive tumors that cannot be adequately treated with TUR. 4,5 In this study we retrospectively reviewed our experience with partial cystectomy for muscle invasive urothelial carcinoma of the bladder to assess long-term local control, survival rates and recurrence patterns associated with this treat- ment. This will allow the establishment of guidelines for our pattern of practice that can then be prospectively evaluated in a more uniform population of patients. Submitted for publication June 11, 2005. Supported by Cancer Center Core Grant CA16672 from the Na- tional Cancer Institute, the National Institutes of Health-Bladder SPORE CA91846 (CPND, MFM, HBG, AMK and ASR) and the T32 training grant. * Financial interest and/or other relationship with Abbott, Bayer/ Onyx and Steba-Biotech. † Financial interest and/or other relationship with TetraLogic Pharmaceuticals, AstraZeneca and Abbott/Vysis. ‡ Financial interest and/or other relationship with Fujirebio Diag- nostics Inc., PhotoCure, Abbott/Vysis, AstraZeneca, Pfizer, UroCor and Dianon. § Correspondence: Department of Urology, Unit 1373, The Uni- versity of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030 (telephone: 713-792-3250; FAX: 713- 794-4824; e-mail: cdinney@mdanderson.org).  Financial interest and/or other relationship with AstraZeneca, GlaxoSmithKline, National Cancer Institute, Canji/Schering- Plough and Abbott/Vysis. See Editorial on page 1987. 0022-5347/06/1756-2058/0 Vol. 175, 2058-2062, June 2006 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2006 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/S0022-5347(06)00322-3 2058