Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage

Patel, Sunil; Wang, Shirley L.; Metcalf, Maynard M.; Gupta, Natasha; Gabrielson, Andrew; Lee, Esther; Rostom, Mary; Pierorazio, Phil; Smith, Arthur L.; Hahn, Noah M.; Schoenberg, Mark; Kates, Max; Hoffman-Censits, Jean H.; Bivalacqua, Trinity J.

doi:10.1016/j.clgc.2021.11.005

Cited by 13 publications

(4 citation statements)

References 30 publications

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“…According to a systematic review, up to one-fourth of the women are affected by metastatic recurrence after an organpreserving approach, similar to ORC and LRC (29). On the other hand, a recent retrospective study did not find any differences in survival outcomes for ROPRC compared to non-ROPRC in women with variant histology and it was suggested, also by other studies, that presence of advanced disease does not preclude ROPRC (33,34).…”

Section: Oncological Safety Of Roprcmentioning

confidence: 94%

“…This is likely due to the generally late diagnosis of bladder cancer in females. Regarding ROPRC, two studies found that RO involvement rates were equal or lower compared to standard RC (33,34). Most women with RO involvement have locally advanced bladder cancer with lymphovascular invasion, trigonal tumors, or concomitant non-bladder primary malignancies, however, intraoperative findings of primary malignancies of the RO are rare (34,44,45).…”

Section: Involvement Of Romentioning

confidence: 99%

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Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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Background and Objective: Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women.Methods: We performed a non-systematic literature review of the available publications in the PubMed database.

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Section: Oncological Safety Of Roprcmentioning

confidence: 94%

Section: Involvement Of Romentioning

confidence: 99%

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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“…Finally, this study does not answer the question of whether oncological outcomes are compromised in females undergoing gynaecological organ‐sparing RC. Although this was never the objective of this study, others have demonstrated the feasibility of pelvic organ‐sparing RC, with similar survival outcomes [28].…”

Section: Discussionmentioning

confidence: 89%

Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study

Lobo,

Uthayanan,

Uribe‐Lewis

et al. 2024

BJU International

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ObjectiveTo report the incidence of malignancy in gynaecological organs removed during radical cystectomy (RC).Patients and MethodsA retrospective multicentre study of 1600 RCs at three high‐volume institutions between January 2009 and March 2022 was performed. Pathological findings in gynaecological organs in female RC specimens were reviewed. Multivariable logistic regression analyses were used to identify predictors of malignant gynaecological organ involvement (GOI) at time of RC.ResultsOverall, 302 females with a median (interquartile range) age of 68 (61–75) years underwent RC for clinical (c)Ta–T4 bladder cancer. In all, 56 patients (18.5%) received neoadjuvant chemotherapy. Malignant GOI was seen in 20 patients (6.6%); the most common single sites of GOI were the uterus (five patients) and vaginal wall (four), followed by cervix (one), and ovaries (one). Nine patients had involvement of more than one gynaecological organ. No females had a primary gynaecological malignancy detected incidentally at RC. Patients with GOI were more likely to have cT3/T4 stage (P < 0.001), preoperative hydronephrosis (P = 0.004), lymphovascular invasion (P = 0.002), and squamous cell carcinoma (P = 0.005) than those without GOI. On multivariable analysis, cT4 stage was an independent predictor of malignant GOI (odds ratio 88.3, 95% confidence interval 10.1–1214; P < 0.001).ConclusionTo our knowledge, we present the largest multi‐institutional study examining malignant GOI in females with bladder cancer undergoing RC. The rate of GOI at the time of RC is low and associated with higher clinical stage. In the absence of clinical or radiological evidence of sexual organ involvement, our results do not support their routine removal at the time of RC.

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“…Retrospective studies have been performed showing that vaginal-sparing RC has equivalent oncologic outcomes and improved sexual function, quality of life, and psychological outcomes. For example, Patel et al (2022) showed that the vaginal-sparing approach did not increase positive margin rates or decrease RFS, CSS, or OS in a single-institution retrospective study [26]. There is still a need for prospective clinical trials in this area.…”

Section: Bladder Removalmentioning

confidence: 99%

Evidence-Based Analysis of the Critical Steps of Radical Cystectomy for Bladder Cancer

D’Andrea,

Melnick,

Yim

et al. 2023

JCM

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Radical cystectomy (RC) is an integral part of the management of patients with advanced-stage bladder cancer. This major oncologic operation is prone to complications resulting in morbidity and mortality. We analyzed the critical steps of open RC, performed an evidence-based review of these steps, and discussed our experience and approach. We conducted a literature review of the open RC technique, identified the critical steps that consistently appeared across different sources, and organized these steps into a framework. PubMed was queried with the critical steps as keywords for relevant articles published from 1 January 2013 to 1 August 2023. We utilized this query to conduct a systematic review of the literature using the outcomes of overall survival and 90-day complication rate. We developed the “Summary for the 10 Critical Operative Steps of Radical Cystectomy”, a concise guide to the approach to open RC. When available, an evidence-based analysis of each critical step was performed. We also included additional components of cystectomy optimization such as pre-habilitation in the preoperative phase, standard versus extended lymphadenectomy, the vaginal-sparing approach to female radical cystectomy, patient-reported outcomes following urinary diversion, the use of a mesh for stoma formation, and the use of the ERAS protocol for postoperative care. An evidence-based assessment of RC may help provide valuable information to optimize surgical techniques and patient outcomes.

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Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage

Cited by 13 publications

References 30 publications

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study

Evidence-Based Analysis of the Critical Steps of Radical Cystectomy for Bladder Cancer

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