Systematic review of the oncological and functional outcomes of pelvic organ-preserving cystectomy compared with standard radical cystectomy in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer

Erik Veskimae (Corresponding Author), Yann Neuzillet, Mathieu Rouanne, Steven MacLennan, Thomas B L Lam, Yuhong Yuan, Eva Compérat, Nigel C Cowan, Georgios Gakis, Antoine G van der Heijden, Maria J Ribal, J Alfred Witjes, Thierry Lebret

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Abstract

Context: Pelvic-organ preserving radical cystectomy (POPRC) for female patients may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC).
Objective: To determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer (BCa).
Evidence acquisition: Medline, Embase, Cochrane controlled trials databases and clinicaltrial.gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard radical cystectomy and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival at >2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment.
Evidence synthesis: The searches yielded 11,941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86 %) having resumed sexual activity within 6 months post-operatively, with median patients’ sexual satisfaction scores 88.5 % ranging from 80% to 100%. Survival outcomes were reported in 7 studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 yr, cancer-specific survival (CSS) was 70-100% and overall survival (OS) 65-100 %. 11 studies reported continence outcomes. Overall daytime and nighttime continence was 58-100% and 42-100%, respectively. Overall self-catheterization rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, narrative synthesis was made. The overall risk of bias was high across all studies.
Conclusion: For well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC in terms of oncological outcomes whilst improving sexual and urinary function outcomes. However, in women undergoing cystectomy, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative setting.
Original languageEnglish
Pages (from-to)12–24
Number of pages13
JournalBJU International
Volume120
Issue number1
Early online date24 Mar 2017
DOIs
Publication statusPublished - 1 Jul 2017

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Cystectomy
Urinary Bladder Neoplasms
Survival
Orgasm
Patient Satisfaction
Catheterization
Sexual Behavior
Publications
Retrospective Studies
Databases
Recurrence

Keywords

  • radical cystectomy
  • urinary bladder neoplasms
  • urinary incontinence
  • sexual function
  • #BladderCancer
  • #blcsm

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Systematic review of the oncological and functional outcomes of pelvic organ-preserving cystectomy compared with standard radical cystectomy in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. / Veskimae, Erik (Corresponding Author); Neuzillet, Yann ; Rouanne, Mathieu ; MacLennan, Steven; Lam, Thomas B L; Yuan, Yuhong ; Compérat, Eva; Cowan, Nigel C; Gakis, Georgios; van der Heijden, Antoine G; Ribal, Maria J; Witjes, J Alfred; Lebret, Thierry.

In: BJU International, Vol. 120, No. 1, 01.07.2017, p. 12–24.

Research output: Contribution to journalArticle

Veskimae, Erik ; Neuzillet, Yann ; Rouanne, Mathieu ; MacLennan, Steven ; Lam, Thomas B L ; Yuan, Yuhong ; Compérat, Eva ; Cowan, Nigel C ; Gakis, Georgios ; van der Heijden, Antoine G ; Ribal, Maria J ; Witjes, J Alfred ; Lebret, Thierry. / Systematic review of the oncological and functional outcomes of pelvic organ-preserving cystectomy compared with standard radical cystectomy in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. In: BJU International. 2017 ; Vol. 120, No. 1. pp. 12–24.
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abstract = "Context: Pelvic-organ preserving radical cystectomy (POPRC) for female patients may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC).Objective: To determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer (BCa). Evidence acquisition: Medline, Embase, Cochrane controlled trials databases and clinicaltrial.gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard radical cystectomy and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival at >2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment. Evidence synthesis: The searches yielded 11,941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86 {\%}) having resumed sexual activity within 6 months post-operatively, with median patients’ sexual satisfaction scores 88.5 {\%} ranging from 80{\%} to 100{\%}. Survival outcomes were reported in 7 studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 yr, cancer-specific survival (CSS) was 70-100{\%} and overall survival (OS) 65-100 {\%}. 11 studies reported continence outcomes. Overall daytime and nighttime continence was 58-100{\%} and 42-100{\%}, respectively. Overall self-catheterization rate was 9.5-78{\%}. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, narrative synthesis was made. The overall risk of bias was high across all studies. Conclusion: For well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC in terms of oncological outcomes whilst improving sexual and urinary function outcomes. However, in women undergoing cystectomy, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative setting.",
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author = "Erik Veskimae and Yann Neuzillet and Mathieu Rouanne and Steven MacLennan and Lam, {Thomas B L} and Yuhong Yuan and Eva Comp{\'e}rat and Cowan, {Nigel C} and Georgios Gakis and {van der Heijden}, {Antoine G} and Ribal, {Maria J} and Witjes, {J Alfred} and Thierry Lebret",
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T1 - Systematic review of the oncological and functional outcomes of pelvic organ-preserving cystectomy compared with standard radical cystectomy in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer

AU - Veskimae, Erik

AU - Neuzillet, Yann

AU - Rouanne, Mathieu

AU - MacLennan, Steven

AU - Lam, Thomas B L

AU - Yuan, Yuhong

AU - Compérat, Eva

AU - Cowan, Nigel C

AU - Gakis, Georgios

AU - van der Heijden, Antoine G

AU - Ribal, Maria J

AU - Witjes, J Alfred

AU - Lebret, Thierry

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Context: Pelvic-organ preserving radical cystectomy (POPRC) for female patients may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC).Objective: To determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer (BCa). Evidence acquisition: Medline, Embase, Cochrane controlled trials databases and clinicaltrial.gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard radical cystectomy and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival at >2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment. Evidence synthesis: The searches yielded 11,941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86 %) having resumed sexual activity within 6 months post-operatively, with median patients’ sexual satisfaction scores 88.5 % ranging from 80% to 100%. Survival outcomes were reported in 7 studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 yr, cancer-specific survival (CSS) was 70-100% and overall survival (OS) 65-100 %. 11 studies reported continence outcomes. Overall daytime and nighttime continence was 58-100% and 42-100%, respectively. Overall self-catheterization rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, narrative synthesis was made. The overall risk of bias was high across all studies. Conclusion: For well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC in terms of oncological outcomes whilst improving sexual and urinary function outcomes. However, in women undergoing cystectomy, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative setting.

AB - Context: Pelvic-organ preserving radical cystectomy (POPRC) for female patients may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC).Objective: To determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer (BCa). Evidence acquisition: Medline, Embase, Cochrane controlled trials databases and clinicaltrial.gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard radical cystectomy and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival at >2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment. Evidence synthesis: The searches yielded 11,941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86 %) having resumed sexual activity within 6 months post-operatively, with median patients’ sexual satisfaction scores 88.5 % ranging from 80% to 100%. Survival outcomes were reported in 7 studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 yr, cancer-specific survival (CSS) was 70-100% and overall survival (OS) 65-100 %. 11 studies reported continence outcomes. Overall daytime and nighttime continence was 58-100% and 42-100%, respectively. Overall self-catheterization rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, narrative synthesis was made. The overall risk of bias was high across all studies. Conclusion: For well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC in terms of oncological outcomes whilst improving sexual and urinary function outcomes. However, in women undergoing cystectomy, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative setting.

KW - radical cystectomy

KW - urinary bladder neoplasms

KW - urinary incontinence

KW - sexual function

KW - #BladderCancer

KW - #blcsm

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DO - 10.1111/bju.13819

M3 - Article

VL - 120

SP - 12

EP - 24

JO - BJU International

JF - BJU International

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