A retrospective study of 29 patients with extensive but non metastatic bladder cancer (T234N+ M0) demonstrated once more the dreadful prognosis of advanced bladder cancer. Only 4 patients are alive without evidence of recurrence with a follow up of 12 to 64 months. The 11 patients whose tumor was too extended for radical cystectomy had a similar survival rate and better quality of survival than the 18 patients who underwent total cystectomy. Recurrence appears quickly (mean time : 11 months) and is mostly metastatic. This study led us to change our therapeutic attitude. We now use systemic preoperative polychemotherapy and we no longer perform radical cystectomy in bulky nodal metastasis.
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