Ten-year experience of radical cystectomy in one center: retrospective analysis and oncological results

Background. Radical cystectomy (RC) remains the primary surgical method for treating bladder cancer. Minimally invasive techniques, such as laparoscopic and robot-assisted cystectomy, are becoming increasingly popular due to their advantages, but they have limitations related to tumor features and patients’ clinical characteristics. To confirm the benefits of minimally invasive RC and address existing limitations, more extensive and carefully controlled studies are necessary.

Aim. To evaluate 10-year oncological outcomes of RC using minimally invasive technologies based on data from a single federal hospital.

Materials and methods. This retrospective, single-center cohort study included the results of 484 RC surgeries (open and laparoscopic) performed between January 2012 and December 2021 (10 years). Due to incomplete data, 29 cases were excluded from the analysis. The primary endpoint of the study was 10-year cancer-specific survival. The secondary endpoints were 10-year overall survival and recurrence-free survival.

Results. Cystectomy using minimally invasive laparoscopic access was performed in the overwhelming majority of patients – 408 (89.7 %) cases, with an absolute growth rate of 1300 % (p <0.001) over a 10-year period. For all patients, 10-year overall survival was 51.1 %, cancer-specific survival was 62.9 %, and recurrence-free survival was 44.1 %. Subgroup analysis based on the type of surgical approach showed a general trend towards reduced risk of death or disease recurrence favoring minimally invasive laparoscopic RC; however, no statistically significant differences were found in 10-year overall survival (hazard ratio (HR) 0.68; 0.39–1.21; p = 0.191), cancer-specific survival (HR 0.55; 0.28–1.08; p = 0.080), and recurrence-free survival (HR 0.87; 0.5–1.52; p = 0.620).

Conclusion. This retrospective cohort study identified two major trends in the surgical treatment of bladder cancer: a significant increase in the use of laparoscopic access by 1300 % over the past 10 years without worsening oncological outcomes, and an increased risk of mortality in patients over 75 years of age.

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