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Outcomes of Partial Cystectomy for Selected Bladder Cancer Patients - Expert Commentary 

Radical cystectomy (RC) is currently the gold standard operative treatment for localized (T2-T4a) muscle-invasive bladder cancer (MIBC) or recurrent high-risk non-MIBC. However, RC can be associated with several complications and can affect the patients’ quality of life. Partial cystectomy (PC) is an important alternative treatment for selected patients, but there is insufficient data on the outcomes of PC as an alternative treatment for MIBC patients. Assessing the effectiveness and complications of PC is critical to establish guidelines for its proper utilization.  

A recent study published by Ebbing et al. in Scientific Reports Scientific Reports evaluated the complications, effectiveness, and quality of life of cT2 cM0 MIBC patients who underwent PC. The investigators identified 27 MIBC patients who had open PC between 1995-2012. The majority of patients (63.0 %) had a Charlson comorbidity grade ≥3, and 48.1% were considered to have severe comorbidity per the Adult Comorbidity Evaluation-27 (ACE-27) score. Following PC, 18.5% had a pT0. The estimated 5-year overall was 53.7%. The estimated 5-year progression-survival was 62.1%. Five (18.5%) patients experienced a local recurrence with MIBC, and the salvage cystectomy rate was 18.5%. All patients were alive within 90-days of the surgery. The study found that 7.4% of patients developed major complications within the first 30 days of the procedure due to wound infection and healing issues. 14.8% had a late complication. Postoperatively, the median (IQR) global health status and QoL score was 79.2 (52.1–97.9). 

This study provides a review of the outcomes and complications of open PC for the treatment of MIBC. Additional prospective studies are needed to establish well-defined criteria for selected patients who could benefit from this procedure. 

Written By: Bishoy M. Faltas, MD, assistant professor of medicine at Weill Cornell Medicine at New York Presbyterian hospital. 

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Reference:
Ebbing J, Heckmann RC, Collins JW, Miller K, Erber B, Friedersdorff F, Fuller TF, Busch J, Seifert HH, Ardelt P, Wetterauer C, Hosseini A, Jentzmik F, Kempkensteffen C. Sci Rep. 2018 May 30;8(1):8360. doi: 10.1038/s41598-018-26089-x.