Clinical outcomes of modified partial cystectomy in muscle-invasive bladder cancer: balancing tumor control and quality of life.

Background: Muscle-invasive bladder cancer (MIBC) is highly aggressive with poor prognosis. Radical cystectomy (RC) with urinary diversion, the standard treatment, impairs patients' quality of life. This study explored modified partial cystectomy (MPC) as a bladder-preserving option, assessing oncological control, perioperative outcomes, and quality of life.

Methods: Patients who underwent partial cystectomy for urothelial carcinoma at the Affiliated Cancer Hospital of Guangzhou Medical University between January 2020 and January 2022 were included. Some received standard laparoscopic partial cystectomy (LPC), while others received MPC with laparoscopic pelvic lymph node dissection and open tumor resection. These were compared with a gold standard group undergoing RC and lymph node dissection, evaluating perioperative, functional, and oncological outcomes.

Results: Among the 57 patients (16 MPC, 18 LPC, 23 RC), LPC patients were older, RC tumors were more commonly located on the trigone, and tumors in the RC group were larger. Major complications were 21.7% in RC, vs. 5.5% in LPC and 6.2% in MPC (P<0.001). Positive margins occurred in 16.67% of LPC patients, and none occurred in MPC or RC (P=0.03). MPC and LPC had similar quality-of-life scores. After 36 months of follow-up, relapse rates were 34.7% in RC, 33.3% in LPC, and 6.2% in MPC (P=0.19). MPC had significantly longer 3-year recurrence-free survival than LPC (P=0.048) and RC (P=0.034), with comparable overall survival across groups.

Conclusions: MPC surpasses LPC in tumor resection, reducing recurrence and enhancing survival. MPC also achieves similar oncological results to RC, making it a promising bladder-preserving alternative for MIBC patients.