The Feasibility and Safety of Reproductive Organ Preserving Radical Cystectomy for Elderly Female Patients With Muscle-Invasive Bladder Cancer: A Retrospective Propensity Score-matched Study.

Objective: To evaluate the feasibility and safety of reproductive organ preserving radical cystectomy (ROPRC) compared to radical cystectomy (RC) for elderly female patients with muscle-invasive bladder cancer.

Methods: We retrospectively studied 135 elderly female patients (aged ≥75 years) who underwent RC followed by cutaneous ureterostomies at our center between January 1, 2007 and December 31, 2017. Eighty-four patients treated with RC, and 51 patients treated with ROPRC, were grouped into 45 pairs. Patient demographics, extensive peri-operative, and oncological data were then recorded and evaluated.

Results: In the matched group, the incidence of short-term and long-term complications in the ROPRC group were lower than the RC group (18.0% vs 28.0%, P = .035; 12.0% vs 22.0%, P = .030). Furthermore, operative time was shorter, estimated blood loss was lower, and bowel recovery was quicker in the ROPRC group (207.5 minutes vs 267.9 minutes, P < .001; 500 mL vs 600 mL, P = .024; 3.0 days vs 4.0 days, P < .001, respectively) compared to the RC group. The recurrence free survival (P = .658), overall survival (P = .604), and cancer-specific survival (P = .361) were all equivalent when compared between the 2 groups with a median follow-up period of 34.0 and 38.0 months, respectively. The surgical approach (RC vs ROPRC) was an independent risk factor for short-term complications (P = .045), duration of operative time (P < .001), estimated blood loss (P = .004), and bowel recovery (P < .001).

Conclusion: This propensity score-matched cohort study showed that ROPRC was both feasible and safe for elderly female patients with muscle-invasive bladder cancer compared to RC, and also had comparable oncological outcomes after a lengthy follow-up period.