Cystoscopic-assisted partial cystectomy: description of technique and results

Background: Partial cystectomyprovides oncological results comparable with those of radical cystectomyin selected patients with invasive bladder cancer without the morbidity associated with radical cystectomyand urinary diversion. We describe a novel technique of partial cystectomythat allows accurate identification of tumor margins while minimizing damage to the rest of the bladder. Methods: During the study period, 30 patients underwent partial cystectomyfor invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopywas done and the light of the cystoscopewas pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy. Results: Patients who underwent partial cystectomyusing the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3 ±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar. Conclusion: The use of a flexible cystoscopeduring partial cystectomyis a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.