A Retrospective Study of the Usefulness of Partial Cystectomy for Advanced Colorectal Cancer With Bladder Invasion

TL;DR

This study compares partial cystectomy and total pelvic exenteration for bladder-invading colorectal cancer, finding similar cancer outcomes but better quality of life with partial cystectomy.

Contribution

The study evaluates partial cystectomy as a less radical alternative to total pelvic exenteration for bladder-invading colorectal cancer.

Findings

Partial cystectomy resulted in shorter surgery time and less blood loss compared to total pelvic exenteration.

Oncological curability and recurrence rates were similar between the two procedures.

Postoperative quality of life was better with partial cystectomy, though urinary symptoms increased.

Abstract

Background and aim

Bladder invasion in colorectal cancer often necessitates total pelvic exenteration (TPE), a highly radical procedure that offers excellent curability but significantly impairs postoperative quality of life (QoL), especially due to urinary diversion. Although TPE is considered the standard approach, partial cystectomy (PC) may be a feasible option in selected patients. Oncological curability and satisfactory QoL may be achieved with appropriate patient selection. This study aimed to evaluate short-term outcomes and voiding-related QoL in patients with colorectal cancer and bladder invasion who underwent either PC or TPE at a single institution.

Methods

This retrospective study included patients diagnosed with colorectal cancer and bladder invasion between May 2011 and February 2023 who underwent TPE or PC. Perioperative factors such as duration of surgery, blood loss, hospital stay, pathological outcomes, and short-term results were compared. In the PC group, postoperative urinary function was assessed using the Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score (IPSS), and IPSS-QoL.

Results

Twenty-two patients were included in this study, with eight and 14 patients in the PC and TPE groups, respectively. The duration of surgery and blood loss (p<0.001 and p=0.012, respectively) were lower in the PC group. Pathological curability and recurrence rates were not significantly different. In the PC group, the median pre- and postoperative IPSSs were 1 and 6, respectively; IPSS-QoL was 3.5 postoperatively. The median OABSS increased from 0.5 to 3.5. Median increases in IPSS and OABSS were 3 and 2, respectively.

Conclusion

With appropriate patient selection, PC may provide oncological outcomes comparable to those of TPE while better preserving postoperative QoL in patients with colorectal cancer and bladder invasion.

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