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Bladder Cancer Treatment (Muscle-invasive Bladder Cancer)

Muscle-invasive bladder cancer refers to cancer that has spread into the muscle wall of the bladder. The primary treatment for muscle-invasive bladder cancer - or bladder cancer that has returned - is removal of the bladder. This is known as a radical cystectomy.

Radical cystectomy is considered the gold standard treatment for this type of cancer,¹ but it is a major operation that significantly changes a person's life.

Besides removing the bladder, surgeons will also remove lymph nodes and nearby organs, if they contain cancer. In men, the nearby organs that may need to be removed are the prostate and seminal vesicles (glands that produce semen). In women, the uterus, ovaries and part of the vagina may need to be removed.

Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body. Options may include a neobladder – a new reservoir made of part of your intestine - or an ostomy bag connected to your urethra through an opening (stoma) in your stomach. Depending on approach used, the surgeon may still need to create a stoma. You may still also need to use a catheter to release the urine several times a day.²

Even if your doctor removes all of the cancer that can be seen during surgery, you may be also given chemotherapy to kill any cancer cells that might be left behind. In fact, research shows that chemotherapy before or after a radical cystectomy may improve survival for men with muscle-invasive bladder cancer.³

There are options when it comes to the type of surgery available to bladder cancer patients, including:

Open surgery - Currently, the majority of bladder cancer operations are performed using traditional open surgery. In this approach, a large abdominal incision is made to manually access the bladder, surrounding tissues and organs. Open surgery is considered very invasive and traumatic on the body.

Laparoscopic surgery – In this approach, the surgeon makes several small incisions, instead of the one large incision used in traditional open surgery. The surgeon uses long, narrow instruments to access and remove the bladder. This surgery may take longer, but recovery is typically less painful.¹ Because of the limitations of the instruments and vision system, your doctor may not recommend laparoscopic surgery for operations considered to be delicate or complex.

da Vinci® Surgery
If your doctor recommends surgery to treat bladder cancer, you may be a candidate for a breakthrough, minimally invasive approach - da Vinci® Surgery. da Vinci Surgery uses state-of-the-art technology to help your doctor perform a more precise operation than conventional instrumentation allows.

da Vinci Cystectomy incorporates the best techniques of open surgery – including comprehensive cancer control – and applies them to a robotic-assisted, minimally invasive approach. da Vinci Cystectomy offers patients several potential benefits over open surgery, including:

• Significantly less pain⁴
• Less blood loss⁴
• Low risk of major complications⁵
• Earlier return to bowel function⁴
• Fast return to normal diet⁵
• Less scarring compared to open surgery

da Vinci Surgery: Less invasive, more precise

For many patients, the precision and dexterity of the da Vinci Surgical System may mean their doctors can offer a minimally invasive bladder cancer surgery. If you are facing bladder cancer surgery, talk to a doctor who performs da Vinci Surgery. To find a da Vinci surgeon, use our surgeon locator.

As with any surgery, these benefits cannot be guaranteed since surgery is unique to each patient and procedure. All surgeries, including da Vinci Surgery, involve risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation.

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While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. All surgeries carry risks of major complications; before deciding on surgery, ask your doctor about all treatment options, as well as their risks and benefits.

Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com

¹Stein JP, Lieskovsky G, Cote R et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001; 19: 666–75
²American Cancer Society. Detailed Guide: Bladder Cancer Surgery. http://www.acsevents.org/docroot/CRI/content/CRI_2_4_4X_Surgery_44.asp
³American Society of Clinical Oncology. Bladder Cancer - Treatment. Cancer.net. www.cancer.net. www.cancer.net/patient/Cancer+Types/Bladder+Cancer?sectionTitle=Treatment
⁴Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Eur Urol. 2010 Feb;57(2):196-201. Epub 2009 Oct 20.
⁵Kauffman EC, Ng CK, Lee MM, Otto BJ, Portnoff A, Wang GJ, Scherr DS. Critical analysis of complications after robotic-assisted radical cystectomy with identification of preoperative and operative risk factors. BJU Int. 2010 Feb;105(4):520-7. Epub 2009 Sep 4.

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