Investigating the Potential to Offer Reproductive Organ Preserving Radical Cystectomy to More Female Bladder Cancer Patients

INTRODUCTION: Traditional radical cystectomy (tRC) in female bladder cancer (BC) patients includes removal of the ovaries, uterus, and anterior vaginal wall. Reproductive organ preserving radical cystectomy (ROPRC) offers less invasive surgery with comparable survival and better functional outcomes for selected patients. The objective of this study is to investigate the current number of ROPRC at our institution and the potential for increased adoption of the procedure based on precystectomy assessment criteria.

PATIENTS AND METHODS: A retrospective cohort study of female patients treated with radical cystectomy between 2017 and 2021 at a single high volume academic center in Denmark. Suspicion of stage T4 was assessed based on precystectomy CT, transurethral resection of bladder tumor with bimanual palpation, and intraoperative assessment at cystectomy. Median follow-up was 36 months for both tRC and ROPRC. The primary outcome was number of ROPRC. The secondary outcome was potential for ROPRC in the tRC population. Frequencies and predictive values were calculated.

RESULTS: A total of 118 female BC patients were included. Four patients underwent ROPRC, all with non-muscle-invasive BC. None had local recurrence. In tRC (n = 114), stage T4 BC was suspected in 31% (35/114) and 14% (16/114) had pT4 at final pathology. There was no suspicion of stage T4 BC in 83 patients, and 82 of these had <pT4 at final pathology, providing a negative predictive value for identifying stage T4 BC before pathology of 99%. The potential for ROPRC in the tRC population was 69% (79/114). Limitations were the retrospective single center study and limited number of ROPRC.

CONCLUSIONS: Only 4 women over a 5-year period underwent complete or partial ROPRC. The preoperative prediction of stage T4 was accurate, which could reflect a potential to offer ROPRC to more than two thirds of female cystectomy patients currently undergoing tRC.