"Modernized" en Bloc Radical Cystectomy Versus Standard Radical Cystectomy: A Nationwide Multi-Institutional...

Area of Science:

• Urology
• Surgical Oncology
• Bladder Cancer Research

Background:

• Standard radical cystectomy (stdRC) for muscle-invasive bladder cancer involves separate pelvic lymph node dissection templates.
• Modernized en bloc radical cystectomy (mEbRC) removes the bladder and associated lymphatic tissue en bloc.

Purpose of the Study:

• To compare oncological and surgical outcomes of mEbRC versus stdRC.
• To evaluate survival rates, including for female patients, and perioperative measures.

Main Methods:

• A propensity score-matched analysis of 935 patients (214 mEbRC, 721 stdRC).
• Matching criteria included age, gender, neoadjuvant chemotherapy, comorbidity index, lymph node metastases, carcinoma in situ, and pT-stage.
• Primary outcome: recurrence-free survival (RFS); secondary outcomes: overall survival (OS), cancer-specific survival (CSS), and perioperative measures.

Main Results:

• No significant differences in complications, readmission rates, or short-term mortality between mEbRC and stdRC.
• Propensity-matched analysis revealed significantly better 5-year RFS (83% vs. 67%), CSS (89% vs. 78%), and OS (81% vs. 68%) for mEbRC (p < 0.001).
• Cox regression confirmed these findings, favoring mEbRC (hazard ratios 0.41–0.50). Significantly improved 5-year OS for female patients in the mEbRC group (86% vs. 60%, p=0.022).

Conclusions:

• mEbRC demonstrates superior oncological outcomes compared to stdRC for muscle-invasive bladder cancer.
• The mEbRC approach offers comparable safety and perioperative profiles to stdRC.
• mEbRC may represent an advancement in surgical technique for bladder cancer treatment, yielding better survival rates.