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Local Involvement of the Urinary Bladder in Primary Colorectal Cancer: Outcome with En-Bloc Resection

¹ Department of Surgical Oncology, Cork Cancer Research Centre, Mercy University Hospital, Grenville Place, Cork, Ireland
² Department of Urology, Cork Cancer Research Centre, Mercy University Hospital, Grenville Place, Cork, Ireland
³ Department of Pathology, Cork Cancer Research Centre, Mercy University Hospital, Grenville Place, Cork, Ireland

Correspondence: Address correspondence and reprint requests to: D. C. Winter, MD; Mayo Clinic, Gonda 9-S, 200 1st Street SW, Rochester, MN 55905, USA; E-mail: winter.desmond{at}mayo.edu

Background: Colorectal cancers that adhere to the urinary bladder require en-bloc partial or total cystectomy to achieve negative tumor margins.

Methods: This prospective study evaluated the outcome of combined bladder resection for carcinoma of the colon or rectum at a unit specializing in gastrointestinal cancer.

Results: Patients (n = 63) with colorectal tumors adherent to the bladder at operation and without distal metastases were followed. Fifty-eight patients (92%) had tumors of the sigmoid colon or upper rectum. Operative morbidity and mortality rates were 18% and 1.5%, respectively. Histological staging demonstrated bladder adherence in 46% (29/63) and invasion in 54% (34/63). Overall disease-specific survival was 54% with a mean follow-up of 7.6 years (range 5–12). Five-year survival for margin-negative patients was 72% (26/36) and 27% (4/15) for node-negative and -positive tumors, respectively. The bladder was closed primarily in 48 patients and reconstructed by enterocystoplasty in 5, with 10 patients requiring urinary diversion.

Conclusions: En-bloc bladder resection for adherent or invading tumors of the colon and rectum achieves good local control, but an infiltrative extravesical margin denotes poor prognosis. The potential for cure in completely excised node-negative tumors is good. Bladder reconstruction is achievable in most patients.

Key Words: Partial cystectomy • Pelvic exenteration • Colorectal cancer