A 53-year-old man was diagnosed with bladder cancer with pelvic and para-aortic lymph node metastases. The clinical stage was cT3bN2M1. He underwent radical cystectomy and ileal conduit construction and retroperitoneal lymph node dissection after showing a partial response to 4 cycles of chemotherapy with methotrexate,vinblastine,doxorubicin and cisplatin (MVAC). Pathology showed prostatic invasion and para-caval lymph node metastasis. Pathological stage was pT4N0M1. After 3 cycles of MVAC therapy as adjuvant chemotherapy,new lymph node metastasis was revealed. He showed a complete response after 4 cycles of chemotherapy with gemcitabine and cisplatin (GC). He received 6 additional cycles of GC chemotherapy. Follow-up computed tomographic scan 3 months after the last chemotherapy showed portal vein thrombosis. He was treated with anticoagulant therapy,which dissolved the thrombus.