Diagnostik und operative Therapie des muskelinvasiven Harnblasenkarzinoms

Background: Muscle-invasive bladder cancer (MIBC) is a great diagnostic and therapeutic challenge. Objective: To present current recommendations for the diagnostics and operative treatment of MIBC. Material and method: Summary of the recommendations of the German S3 guidelines on urinary bladder cancer and a selective literature search in PubMed. Results and discussion: Histologically, MIBC can as a rule be clearly distinguished from the prognostically more favorable non-muscle-invasive bladder cancer; however, due to limitations of imaging procedures, accurate preoperative tumor staging and thus a further risk estimation is only possible to a limited extent. In general, appropriate local tumor control can be achieved by radical cystectomy (in combination with perioperative systemic therapy) even in tumors which have already reached or crossed organ boundaries; however, in a large number of patients recurrences will occur within the first years after radical cystectomy, which as a rule can only be treated with palliative intent. While the diagnostic value of an accompanying systematic pelvic lymphadenectomy is generally accepted, the therapeutic benefits with improved postoperative outcome is still under debate. Moreover, it is still unclear whether new minimally invasive surgical techniques differ significantly from conventional open surgical procedures with respect to oncological outcome. Even today, radical cystectomy is associated with a relatively high morbidity and significant mortality, especially in elderly patients. By improving the perioperative management, e. g. in the context of fast-track protocols, the morbidity can be demonstrably reduced.