| 【Background and Purpose】:Muscle-invasive bladder cancer(MIBC)has placed a certain burden on patients and society because of its high incidence and related mortality.The combined radical cystectomy(RC)and pelvic lymph node dissection(PLND)is the gold standard for treatment of MIBC.However,RC has drawbacks such as more surgical complications and poor postoperative quality of life.Presently,more and more patients seek for a bladder preservation therapy,hoping to get better tumor control effect.Partial cystectomy(PC)as a bladder-preserving strategy has shown satisfactory therapeutic effect,whereas its clinical applications have some limitations and shortcomings.The present study aims at expanding the clinical applicability of PC by using a modified PC(MPC)procedure and then further discussing its clinical efficacy and safety in a highly selected group of MIBC patients.【Method】:This study is a retrospective analysis.The data were derived from the hospitalization data and follow-up data of patients with Muscle-invasive bladder cancer(MIBC)in our hospital from 2017 to 2022.According to the criteria,a total of 41 MIBC patients were included in the analysis,of which 16 undergoing modified partial cystectomy(MPC)+ pelvic lymph node dissection(PLND),and 25 undergoing radical cystectomy(RC)+ pelvic lymph node dissection(PLND)+urethral diversion(UD).The general data,perioperative data and postoperative recurrence survival of the two groups were compared.【Result】:A total of 41 MIBC patients were included in this study,with an average follow-up time of 30.66 months.There was no significant difference in sex ratio,age,TNM stage,hypertension,diabetes and ASA grade between MPC group and RC group(all P>0.05).Compared with the RC group,the MPC group had shorter operation time(223.56±42.47 min vs 339.88±63.931 min,P<0.001),less intraoperative blood loss(55.0 vs.210.0 m L,P<0.001),and shorter postoperative time spent on food intake resumption(2.0vs.7.0 days,P< 0.001).Time to removal of pelvic drain(8.4vs.11.9 days,P < 0.001)and postoperative hospitalization time(11.5vs.15.0 days,P =0.002)were significantly shorter,and the total cost of hospitalization(81170.5vs.109140 RMB,P<0.001)was also lower.There was no significant difference between the two groups in tumor stage,pathological stage,pathological grade,positive rate of tumor margin,positive rate of lymph node,tumor size and proportion of postoperative adjuvant chemotherapy(P>0.05).The incidence of complications in the MPC group was significantly lower than that in the RC group(31.25%vs.60%,P=0.072),and the FACT-BL-BBS score was higher(28.5vs.23.0,P<0.001).The result of Kaplan-Meier curve analysis demonstrated comparable tumor recurrence rate and survival rate between the two groups,and that the differences between the two groups had no statistical significance(Log rank test,P >0.05).Moreover,multi-variate COX regression analysis suggested that the recurrence and survival of patients were not affected by the treatment group(P >0.05).【Conclusion】:MPC contributes to more rapid recovery,less complications,and higher quality of life postoperatively in highly selected patients.More importantly,MPC shows similar effects with RC in tumor control in MIBC patients,and patients receiving RC and MPC exhibit comparable tumor recurrence rate and survival rate.Thus,MPC can be employed as an alternative for bladder preservation during tumor treatment. |
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