Abstract
To evaluate the oncological results, associated complications, and postoperative health-related quality of life (HR-QoL) in patients treated with partial cystectomy (PC) for muscle-invasive bladder cancer (MIBC). 27 patients who underwent open PC for cT2 MIBC were included. A simple Cox’s proportional hazards regression model was used to assess the association of several potential prognostic factors with survival. Postoperative HR-QoL was assessed with the EORTC (European Organisation for the Research and Treatment of Cancer) QLQ-C30 questionnaire version 3.0. Final pathological tumour stages in PC specimen were: pT0: 18.5%, non-MIBC: 3.7%, MIBC: 74.1%, pCIS: 14.8%. Estimated 5-year overall- and progression-free survival rates were 53.7% and 62.1%. Five (18.5%) patients experienced local recurrence with MIBC. Overall, the salvage cystectomy rate was 18.5%. The 90-day mortality rate was 0%. Significant risk factors for progression-free survival were vascular invasion (HR 5.33) and tumour multilocularity (HR 4.5) in the PC specimen, and a ureteric reimplantation during PC (HR 4.53). The rates of intraoperative complications, 30- and 90-day major complications were 7.4%, respectively and 14.8% for overall long-term complications. Postoperatively, median (IQR) global health status and QoL in our PC cohort was 79.2 (52.1–97.9). Open PC can provide adequate cancer control of MIBC with good HR-QoL in highly selected cases. Open PC can lead to long-term bladder preservation and shows an acceptable rate of severe perioperative complications, even in highly comorbid patients.
Highlights
To evaluate the oncological results, associated complications, and postoperative health-related quality of life (HR-QoL) in patients treated with partial cystectomy (PC) for muscle-invasive bladder cancer (MIBC). 27 patients who underwent open PC for cT2 MIBC were included
One (3.7%) patient suffered from an incidental subcutaneous metastasis in the abdominal wall, which was treated with local resection during PC
With more stringent selection criteria that limits PC to patients with a solitary primary MIBC-tumour, without concomitant Carcinoma in situ (CIS) or a history of non-MIBC, and feasible for full-wall resection with an adequate safety margin, 5-year Overall survival (OS) rates of 53–70% and recurrence-free survival (RFS) rates of 40–64% have been reported in more recent series[7,8,9,10,22,23,24]
Summary
To evaluate the oncological results, associated complications, and postoperative health-related quality of life (HR-QoL) in patients treated with partial cystectomy (PC) for muscle-invasive bladder cancer (MIBC). 27 patients who underwent open PC for cT2 MIBC were included. To evaluate the oncological results, associated complications, and postoperative health-related quality of life (HR-QoL) in patients treated with partial cystectomy (PC) for muscle-invasive bladder cancer (MIBC). Open PC can lead to long-term bladder preservation and shows an acceptable rate of severe perioperative complications, even in highly comorbid patients. Radical cystectomy (RC) is considered to be the accepted gold standard treatment for patients with localized (T2-T4a) muscle-invasive bladder cancer (MIBC) or recurrent high-risk non-MIBC2. Alternative therapeutic options for high-risk patients, like organ-sparing partial cystectomy (PC) or radiochemotherapy following radical transurethral resection of the bladder tumour (TURBT), have gained attention. Recommendations, but argue that the decision regarding bladder-sparing or radical cystectomy in elderly patients with invasive bladder cancer should be based on tumour stage and comorbidity[2]
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