Update on How to Improve the Outcome of Radical Cystectomy: A Systematic Review

Abstract

Context Radical cystectomy (RCX) is the most difficult urologic procedure. It is usually performed in patients with morbidities and associated with a high rate of complications. So, every effort must be done to improve the outcome of this surgery. Objective This systematic review tries to put an up to date analysis of the literature on how to improve the outcome of RCX. Evidence acquisition A systematic literature search in the PubMed and Cochrane databases was performed from 1990 to July 2022 in English language using the keywords ‘‘radical cystectomy’, ‘Enhanced recovery’ and ‘Improved outcome’. Prospective studies were preferred; however, retrospective studies were used when no prospective studies were available. Evidence synthesis In all, 237 relevant articles were identified and 46 articles were included in this systematic review. RCX may be associated by complications that may reach 70%. Preoperative patient preparation, optimization and counseling are critical. Enhanced recovery after surgery protocols should be adopted. The radicality of surgery is affected by the use of neo-adjuvant and/or adjuvant therapy, timing of surgery, the presence of a well-organized team and the surgeon experience. Ureteral dissection, urethral stump preparation and nerve sparing are three important steps during RCX greatly affecting the function of the following reconstructive step. Close follow up after RCX especially in the first two years is critical. Conclusions Multiple factors should be followed to achieve good RCX. Regular skilled operative team, high volume surgeon, well equipped operative theater, excellent postoperative care are keys of success.