Gynecologic-tract sparing radical cystectomy with long term result: report of 55 cases

Abstract

Objective To report a series of female patients with bladder cancer who underwent gynecologic-tract sparing radical cystectomy with long term follow-up. Methods Fifty-five female patients between the ages of 25 and 82 years who underwent gynecologic-tract sparing radical cystectomy between 1990 and 2010 were reviewed retrospectively.Pathologic characteristics and survival ( overall and cancerspecific) were reported.Survival was estimated using Kaplan-Meier methods,and Cox proportional hazards regression analyses were performed to determine factors associated with mortality. Results Five patients were lost in follow up.Fifty-five women with a mean follow-up of 55.2 months were analyzed.The 3,5 and 10-year cancer specific survival (CSS) was 65％,61％ and 61％,respectively,and the corresponding overall survival (OS) was 61％,54％ and 42％,respectively.For patients with organ confined disease ( ≤ pT2N0M0) the 5-year CSS and OS was 84％ and 72％,while for those with non organ confined disease ( ≥pT3N0M0) the 5-year CSS and OS reduced to 29％ and 29％.Pathologic lymph node status (HR =3.877,P =0.019) and pathologic staging ( HR =3.992,P =0.011 ) were the only clinical or pathologic characteristics significantly associated with survival. Conclusions For patients with pathologically organ-confined bladder cancer ( ≤ pT2 N0 M0 ),gynecologic-tract sparing radical cystectomy is an oncologically safe treatment modality,while for those with ≥ pT3N0M0 or positive pelvic lymph nodes,gynecologic-traet sparing radical cystectomy may need large scale randomized control trials to justify its validity,pathological stage and lymph node status are the most important key points when choosing appropriate patients. Key words: Urinary bladder neoplasms; Carcinoma; Female; Cystectomy; Retrospective studies