Standard cystectomy fits all: truth or myth?

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• Radical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion is standard for muscle-invasive bladder cancer (BC).
• This surgery carries significant morbidity and mortality risks.
• Organ-sparing and urinary diversion techniques require careful preoperative patient selection.

Purpose of the Study:

• To highlight the importance of individualized patient selection for radical cystectomy (RC).
• To emphasize the role of organ-sparing procedures and tailored urinary diversion in bladder cancer (BC) management.
• To advocate for a personalized approach to RC, moving beyond a 'standard' procedure.

Main Methods:

• Review of current treatment guidelines and surgical practices for bladder cancer (BC).
• Analysis of factors influencing preoperative patient selection for RC.
• Discussion of various organ-sparing techniques (bladder, nerve, seminal vesicle sparing) and urinary diversion options.

Main Results:

• Individualized RC approaches can optimize oncological outcomes.
• Careful patient selection minimizes surgical morbidity and mortality.
• Tailored surgical steps and urinary diversion reduce avoidable side effects.

Conclusions:

• Personalized radical cystectomy (RC) is crucial for maximizing oncological safety in bladder cancer (BC).
• Considering patient performance status, comorbidities, and tumor characteristics leads to better outcomes.
• The "standard" cystectomy is evolving towards individualized, organ-sparing strategies.