Radical surgery in patients with bladder cancer: long-term outcomes

BACKGROUND: Radical cystectomy with pelvic lymphadenectomy is the mainstay of treatment for muscle-invasive bladder cancer. Reported 5- and 10-year survival rates after surgery vary widely.

AIM: This study aimed to evaluate survival outcomes and the incidence of local recurrence in patients with bladder cancer following radical cystectomy.

METHODS: A cohort study with prospective outcome assessment included 407 patients with bladder cancer who underwent radical cystectomy with various types of urinary diversion between 1995 and 2025. The cohort comprised 344 men (86.4%) and 63 women (13.6%). 5- and 10-year overall survival and cancer-specific survival were analyzed.

RESULTS: Postoperative mortality was observed in 12 patients (3.1%). Early postoperative complications occurred in 136 patients (33.6%), and late complications in 117 patients (28.9%). Local pelvic recurrence after radical cystectomy was detected in 33 patients (8.5%). Overall survival at 10 years of follow-up was 43.4%, whereas 10-year cancer-specific survival reached 47.2%. In patients without regional lymph node metastases, 2- and 5-year overall survival rates were 81.2% and 67.2%, respectively; in patients with lymph node metastases, these rates were 46.9% and 13.9%. Cancer-specific survival in the lymph node–negative group was 83.6% at 2 years and 70.7% at 5 years, whereas in the lymph node–positive group it was 51.0% and 15.1%, respectively. Increasing tumor stage and histopathological grade were associated with a progressive decline in both overall and cancer-specific survival.

CONCLUSION: Tumor stage, lymph node status, and histopathological grade exert a substantial independent impact on overall and cancer-specific survival in patients with bladder cancer following radical cystectomy.