Patterns of recurrence of bladder carcinoma following radical cystectomy

The purpose of this study was to describe the imaging features and patterns of disease in patients with recurrent bladder carcinoma following radical cystectomy. A retrospective review was made of the CT and MR findings in 42 patients (33 male, 9 female, mean age 65.1 years) with histologically verified transitional cell carcinoma of the bladder, who developed recurrent disease following radical cystectomy. Histology confirmed T2 disease in 7 patients, T3 disease in 26 patients and T4 disease in 9 patients. The tumour grade was G3 in 38 patients and G2 in 4 patients. The CT (n = 42) and MR imaging (n = 9) obtained at disease relapse were reviewed, noting the sites of disease recurrence and their imaging appearances. The mean time to recurrence following cystectomy was 14.6 months (range 2–50 months). Patients with T2 disease had a significantly longer time to recurrence compared with patients with T3 or T4 disease (22.7 vs. 13.0 months, student t-test, P < 0.05). The most common pattern of recurrence was pelvic lymphadenopathy (55%). Retroperitoneal lymphadenopathy was common (33%) and was the only site of nodal disease in 10%. Local pelvic recurrence (45%) appeared as a soft tissue mass, which involved muscle, urethra or vagina. Sites of distant metastasis included the liver (19%), bone (12%) and lungs (10%). Liver metastasis was associated with nodal disease in the majority (80%). The sites of recurrence of bladder cancer following radical cystectomy are described. Pelvic lymph node involvement is the most frequent site of disease recurrence despite the fact that pelvic lymph node dissection is performed as part of the standard procedure of radical cystectomy.