En bloc radical cystectomy: An overview of the technique and oncological results.

Content Provider	Europe PMC
Author	Kjøbli, Eirik Salvesen, Øyvind Langørgen, Sverre Størkersen, Øystein Wibe, Arne Arum, Carl‐Jørgen
Abstract	AbstractObjectivesTo reduce recurrence after radical cystectomy (RC), we developed a technique based on the principles of the circumferential resection margin used during total mesorectal excision for rectal cancer, namely, en bloc radical cystectomy (EbRC).Patients and methodsThe study included all patients in Mid‐Norway (population of 739 k) with high‐grade superficial or muscle invasive bladder cancer considered for radical treatment according to European guidelines, from January 2012 to August 2021, except for three patients receiving trimodal therapy. One hundred forty‐five patients were treated with EbRC and 188 patients with standard RC (stdRC). There were no exclusion criteria. Both groups included open and robot‐assisted techniques. EbRC entails cystectomy with extended pelvic lymph node dissection. The technique focuses on systematic uninterrupted mobilisation of all lymphatic tissue from the circumferential resection margin towards the bladder pedicles, and resecting the tissue en bloc with the bladder.ResultsThe 3‐year recurrence‐free survival (RFS) was 86% for EbRC versus 67% for stdRC. The hazard ratio for overall survival in multivariable cox regression analyses after EbRC versus stdRC was 0.30 (95% CI 0.16–0.57, p ≤ 0.001). The improved outcomes persisted in propensity score‐matched analyses. There were no differences in Clavien–Dindo 3 and 4 complications (12.4% vs. 11.7%), nor 90‐day mortality (2.1% vs. 1.6%).ConclusionImproved oncological results with EbRC versus stdRC mirror the historical data after total mesorectal excision was initiated over 35 years ago in rectal cancer surgery. EbRC is safe and the preliminary oncological results are promising.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC9931536&blobtype=pdf
Page Count	11
Journal	BJUI Compass
Volume Number	4
DOI	10.1002/bco2.190
PubMed Central reference number	PMC9931536
Issue Number	2
PubMed reference number	36816150
e-ISSN	26884526
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2022-09-18
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.
Subject Keyword	bladder cancer cystectomy en bloc local recurrence lymph node dissection lymph node excision oncologic results urinary bladder neoplasms urothelial cancer
Content Type	Text
Resource Type	Article
Subject	Urology