Organ-sparing surgery in urology: partial cystectomy

While radical cystectomy continues to be the gold standard for surgical management of muscle invasive bladder cancer, there has been a renewed interest in partial cystectomy as a viable treatment alternative. The purpose of this review is to summarize and discuss the recent literature regarding partial cystectomy for bladder cancer.

Utilization of partial cystectomy has remained stable, at a rate of 7-10% of all cystectomies performed nationally. Additionally, recent population-based series as well as single institution cohorts have found that partial cystectomy did not compromise survival when compared to radical cystectomy. While patients may recur, those with organ-confined disease had no difference in survival following salvage cystectomy when compared to primary radical cystectomy. Current data indicate 14% of patients experience an in-hospital complication, which is a marked decrease compared to radical cystectomy. Finally, innovations in surgical technique, such as robotics, as well as the inclusion of partial cystectomy into trimodal therapy, offer exciting new frontiers in bladder cancer treatment.

Once maligned, partial cystectomy now represents a standard-of-care option for management of bladder cancer. Although additional research is needed to clarify patient selection and outcomes, partial cystectomy is an important treatment option for appropriately selected patients.