Long-term Outcomes of Partial Cystectomy for Urothelial Carcinoma in the Era of Bladder Preservation - 09/05/26

Doi : 10.1016/j.urology.2026.04.011

Austin Martin ^a, Chloe Shi ^a, Gianni Morales Martinez ^a, Cameron Britton ^a, Prabin Thapa ^b, Abhinav Khanna ^a, Stephen A. Boorjian ^a, Matthew K. Tollefson ^a, Paras Shah ^a, Robert Jeffrey Karnes ^a, Igor Frank ^a, Vidit Sharma ^a,^⁎

^a Department of Urology, Mayo Clinic, Rochester, MN

^b Department of Health Sciences Research, Mayo Clinic, Rochester, MN

^⁎ Address correspondence to: Vidit Sharma, M.D., Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. Department of Urology, Mayo Clinic 200 1st St SW Rochester MN 55905

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 09 May 2026

ABSTRACT

Objective

To compare perioperative complications, oncologic outcomes, and patient-reported outcomes between partial cystectomy (PC) and radical cystectomy (RC).

Methods

We queried a prospectively maintained database to identify patients undergoing PC and RC for UCB between 1980-2020. Multivariable logistic regression compared 90-day major complications. Multivariable Cox regression examined oncologic outcomes. Quality of life (QoL), urinary symptoms, and decisional regret were assessed in survivors using validated survey instruments.

Results

Among 277 PC patients and 3474 RC patients, PC was associated with fewer 90-day major complications (16.2% vs 33%, P < .01) and readmissions (5.8% vs 16.1%, P < .01) After PC, the 5-year intravesical recurrence risk was 40% and 5-year salvage cystectomy risk was 21%. PC did not compromise metastasis-free (HR 1.06, P = .59) or cancer-specific survival (HR 1.13, P = .21). Survey response rates were 43% (35/81) for PC and 18% (217/1176) for RC. QoL ( P = .88) and decisional regret ( P = .217) were similar between groups. PC patients had less financial difficulty (6% vs 24%, P = .01) and were less likely to feel less physically attractive (30% vs 51%, P = .04). Male PC patients reported less difficulty with erection (58% vs 87%, P < .001) and ejaculation (35% vs 78%, P < .001).

Conclusion

Well-selected PC provides similar oncologic outcomes to RC with less perioperative morbidity and improved QoL. While intravesical recurrence and salvage cystectomy remain risks, guidelines should incorporate PC with adequate postoperative monitoring as an option for select patients with muscle-invasive UCB.

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