Radical cystectomy: a review of techniques, developments and controversies

Abstract

Radical cystectomy (RC) with urinary diversion is considered the standard treatment for muscle invasive bladder cancer (MIBC). As one of the most challenging surgical techniques performed by urologists, RC was described many decades ago, and yet patient morbidity rates have remained stagnant over the years.This review outlines the most recent indications and techniques for RC and analyses the current landscape of complications after cystectomy. There is significant room for improvement with respect to both oncologic and functional outcomes after RC. Future efforts will need to focus on unifying reporting methodology, optimal patient selection criteria, enhanced surgical techniques and peri-operative care pathways, and technological advances to improve patient outcomes.

Treatment patterns and outcomes of BCG-treated non-muscle invasive bladder cancer patients in Germany

“…This latter explanation is supported by a recent multi-centre survey of physicians in 8 countries treating BCG-unresponsive NMIBC patients in which German physicians reported that mitomycin C would be the rst choice of treatment for BCG-unresponsive patients not eligible for cystectomy (12). However, intravesical chemotherapy is considered "oncologically inferior" to radical cystectomy, a procedure known to be associated with considerable peri-operative complications and reduced quality of life (15,16). As such, there is a clear need for novel bladder-preserving treatments for the signi cant number of patients with NMIBC recurrence or progression (17).…”

Radical cystectomy, bilateral lymphadenectomy and native ureteral ligation in a patient with history of kidney transplantation

“…Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the gold standard treatment for muscle-invasive BCa [ 7 ]. The prognostic and therapeutic value of PLND in patients undergoing RC for urothelial cancer cannot be overstated; however, the optimal extent of dissection remains controversial [ 8 ].…”

Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis

“…Numerous studies highlight similar oncological outcomes and lower adverse outcomes, with the potential to improve surgeon precision and dexterity whilst reducing surgeon fatigue, though higher operating costs have restricted its widespread adoption. 8 Because of increasing awareness and concerns about functional implications of standard RC, there is growing interest in organ-sparing cystectomy (OSC) techniques. These techniques aim to maintain similar oncological outcomes to RC but with improvement in sexual and urinary outcomes.…”

“…Owing to technological advancements, robotic‐assisted RC has grown in popularity in high volume centres. Numerous studies highlight similar oncological outcomes and lower adverse outcomes, with the potential to improve surgeon precision and dexterity whilst reducing surgeon fatigue, though higher operating costs have restricted its widespread adoption 8 …”