ROS and Nerve-Sparing Radical Cystectomy May Be Underused in Women With Bladder Cancer

A survey of US urologic oncologists suggests that reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy may be underused in women with bladder cancer. 

Most oncologists surveyed said they routinely perform a hysterectomy and do not spare the neurovascular bundle in premenopausal patients with organ-confined disease. Nearly half of respondents said they routinely perform oophorectomy in these patients, and nearly 20% of respondents said they routinely resect a portion of the vagina.

These findings and other results from the survey were published in Clinical Genitourinary Cancer.

Researchers reported survey data for 101 urologic oncologists who belonged to the Society of Urologic Oncology, had performed a female radical cystectomy, and completed all survey questions about the operative approach they used in premenopausal women. 

Most respondents were fellowship-trained in urologic oncology (83.2%) and were in academic practice (80.2%). Few respondents were women (9.9%). The median time in practice was 9 years. 

Respondents had performed a median of 5.5 female radical cystectomies in the 12 months prior to the survey, and 31.7% of respondents said they had performed at least 10 female radical cystectomies in the past 12 months.

Most respondents (79.2%) said they routinely resected the uterus or cervix when performing radical cystectomy in premenopausal patients with clinically localized T2 muscle-invasive bladder cancer or non-muscle invasive bladder cancer that had failed intravesical therapy.

Most respondents (67.3%) said they routinely resected the neurovascular bundle in this patient group, 48.5% of respondents said they routinely resected the ovaries, and 18.8% said they routinely resected a portion of the vagina.

Overall, 17.8% of respondents said they never spare the uterus or cervix in these patients, 20.8% of respondents never spare the neurovascular bundle, 5.9% never spare the ovaries, and 1.0% never spare a portion of the vagina.

Respondent characteristics such as sex, age, academic practice, urologic oncology fellowship training, and years in practice were not significantly associated with any of these outcomes. 

Most respondents (70.3%) said they were less likely to spare the uterus or cervix when performing radical cystectomy in postmenopausal patients with organ-confined disease. A majority of respondents (69.3%) said they were less likely to spare the ovaries, 43.6% were less likely to spare the neurovascular bundle, and 22.8% were less likely to spare a portion of the vagina. 

Less than half of respondents (41.6%) said the type of urinary diversion impacted whether they performed ROS or nerve-sparing radical cystectomy. 

“We identified significant gaps in adoption of female ROS and nerve-sparing RC [radical cystectomy] techniques for patients with organ-confined disease, despite evidence that ROS and nerve-sparing techniques are oncologically safe and can optimize functional outcomes in select patients,” the researchers wrote. “Future efforts should improve provider training in and education about ROS and nerve-sparing RC to improve postoperative outcomes among female patients.”

Reference

Gupta N, Kucirka L, Semerjian A, et al. Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the U.S. Clin Genitourin Cancer. Published online January 26, 2023. https://doi.org/10.1016/j.clgc.2023.01.010

This article originally appeared on Cancer Therapy Advisor