Surgical factors in the treatment of superficial and invasive bladder cancer.

Tumor stage, grade, and variations in biologic behavior are primary features that largely determine bladder cancer outcomes. Quality of surgery used to assess and treat bladder tumors is critical to a successful outcome. Diagnosis, prognosis, local tumor control, and survival are highly dependent on surgical factors associated with the quality of surgical methods. In cases of superficial bladder tumors, this involves an aggressive TUR of all visible and suspected tumors, including a second resection in most cases. For invasive bladder cancers, radical cystectomy and a complete PLND are required. Both procedures require a high level of skill to achieve a successful outcome. Urologists have no control over the extent of disease or tumor biology, but can control how they evaluate and treat patients. The challenge is how to get better at maximizing surgical efforts. The who and how of surgery in bladder cancer does indeed matter.