[Is there a role for partial cystectomy in the treatment of infiltrating bladder cancer? (2nd part)].

Experimental studies and the clinical course have shown that bladder cancer is confined to the bladder wall for some time, during which optimal treatment by complete surgical excision can be achieved. Failures are most often due to the presence of distant metastasis at the time of surgery and most patients invariably die although local and regional control of the tumor have been achieved. It is difficult to evaluate the benefits that neoadjuvant measures (radio and chemotherapy) contribute to surgery, basically due to the difficulty in classifying the tumor with precision. Preoperative chemotherapy in patients with less than a 40% likelihood of metastasis is unreasonable since 60% will not require it and will be unnecessarily exposed to the side effects of the cytostatic agents, which are not negligible. Furthermore, a considerable number of candidates to partial surgery have no metastasis at the time of diagnosis, therefore preoperative chemotherapy is not useful. It would be more reasonable to give chemotherapy postoperatively to those that are more likely to require it. Radiotherapy will not prevent tumor recurrence and is ineffective in carcinoma in situ. Furthermore, surgery is sufficiently aggressive in regard to the tumor and the possible dissemination to the lymphatics to require adjunctive measures with locoregional effects.