We evaluated transurethral resection of bladder tumor (TUR) for stage T1b and T2 bladder cancers by reviewing our long-term results from 181 patients. All were followed for a minimum of 5 years or until death. In 29 patients with a stage T1b tumor treated by TUR, the 5- and 10-year survival rates were 82.5 ± 7.1 and 73.4 ± 8.8. Bladders were successfully preserved in 16 patients, whereas seven patients died of cancer, all of whom experienced tumor recurrence and progression at the same site as the initial lesion (true local recurrence). Conservative treatment is supposed to be indicated for a stage T1b tumor because more than half could be treated successfully by TUR. However, considering the true local recurrence, for which incomplete resection of primary lesion seems responsible, we believe that re-TUR (a second resection of the primary lesion area) is essential to evaluate the residual tumor. Radical cystectomy should subsequently be considered after re-TUR proved residual tumor because conservative treatment no longer appears reasonable and places the patients at undue risk regarding serious disease progression. As for eight patients with a stage T2 tumor treated by TUR, only one had no recurrence. The others died of recurrence of invasive tumors. In contrast, the 5- and 10-year survival rates of the patients treated by cystectomy were both 63.6 ± 14.5%. Based on these data, radical cystectomy should be required as initial treatment for a stage T2 tumor.
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