While radical cystectomy (RC) remains the gold standard treatment for muscle invasive bladder cancer, its association with significant patient morbidity has driven the search for bladder-preserving alternatives. Partial cystectomy (PC) may be an effective alternative to RC, offering reduced surgical morbidity and preserved urinary tract continuity and sexual function. Despite these potential advantages, the national rate of PC is only 9.7%, primarily due to concerns over local recurrences and inferior outcomes.
Izak Faiena, MD, a urologist at NewYork-Presbyterian/Columbia, worked with his colleagues to recently complete a study to examine differences in survival in patients who underwent RC or PC, and the results were published in Urologic Oncology in August 2023. The retrospective study was conducted using the National Cancer Database (NCDB) to identify patients with muscle invasive bladder cancer who underwent RC or PC between 2003 and 2015. From this database, 22,534 patients were identified, of which 6% were treated with PC.
“Bladder cancer is a multifocal cancer, meaning just because it was in one area doesn’t mean it won’t come up in another area in the bladder. In other words, having just one positive area doesn’t preclude the cancer from being in other areas of the bladder. That’s one of the challenges with offering a patient a PC. The cancer can potentially recur and progress into other areas of the bladder,” says Dr. Faiena.
The study found that patients treated with RC had longer overall survival rates than patients treated with PC (67.8 versus 54.1 months). However, the researchers identified a subcohort of PC-treated patients with very confined tumors that did equally as well as patients treated with RC in terms of overall survival. Further, PC treatment in this subcohort of patients was associated with an increased time between surgery and the need for systemic therapy or death. Results from this study suggest physicians may be able to find patients with localized, small tumors within the bladder that can be removed with partial cystectomy alone.
Patients with a confined tumor that is muscle invasive, with no positive lymph nodes, and a small tumor defined as less than 5cm can potentially consider or discuss partial cystectomy because it appears potentially safe to do compared with radical cystectomy.
— Dr. Izak Faiena
The team behind this study hopes that this research will help to add to the muscle invasive bladder cancer literature and potentially prompt more definitive studies to determine if PC can be safely done in a subset of patients.
