Pelvic organ-sparing robot-assisted radical cystectomy in women with bladder cancer

Objectives To investigate the oncological and complication outcomes in women who have undergone pelvic organ-sparing robot-assisted radical cystectomy (RARC). Patients and Methods We conducted a retrospective, multicentre cohort study of women with bladder cancer undergoing RARC with intracorporeal urinary diversion. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS), and secondary outcomes were 30- and 90-day high-grade complications in patients undergoing organ-sparing RARC vs non-organ-sparing RARC. Kaplan-Meier analyses, the log-rank test and Cox proportional hazard models were used to assess the associations of pelvic organ-sparing RARC with both OS and CSS. The Mann-Whitney test and chi-squared and Fisher's tests were used to compare continuous and categorical variables, respectively. Results A total of 269 women underwent RARC, of whom 81 underwent pelvic organ-sparing RARC. There was no statistically significant difference between the groups in terms of clinical or pathological T stage, and the recurrence rates were similar in the two groups. There were no significant differences in CSS or OS between the groups. The two groups had similar complication profiles and rates. The incidence of high-grade (Clavien-Dindo grade >= 3a) complications was similar in the two groups: organ-sparing vs non-organ-sparing RARC: 13% vs 14% for early complications (P = 0.87) and 7% vs 6% (P = 0.70) for late complications. Conclusions Women with bladder cancer who underwent pelvic organ-sparing RARC and intracorporeal urinary diversion had similar oncological and complication outcomes compared to those who underwent non-organ-sparing RARC. Pelvic organ-sparing RARC could be considered in well selected women with bladder cancer, resulting in improved quality of life and functional outcomes.