Data from 386 patients who underwent RC and ileal loop diversion for urothelial carcinoma between February 2019 and May 2025 were retrospectively analyzed. All procedures were performed by urooncologists with at least 10 years of experience in major oncologic surgery and a minimum annual volume of ten radical cystectomies at a high-volume tertiary cancer center, with the choice of surgical technique left to the discretion of the operating surgeon. Each patient underwent an extended pelvic lymph node dissection.
Sixty-nine patients with insufficient data or a diagnosis of non-urothelial bladder cancer were excluded from the study. The data of 317 patients were included in the study. The Institutional Review Board of Ankara Bilkent City Hospital approved this study (TABED1/1513/2025, Date: 2025-10-22).
Before undergoing RC, every patient received a preoperative TURBT. Subsequently, comprehensive staging with total-body computed tomography (CT) was carried out for staging.
Following diagnostic evaluation, patients were referred to a medical oncologist for cisplatin-based NAC. Eligibility for NAC was determined by a multidisciplinary team including urooncologists and medical oncologists according to contemporary guideline recommendations. Patients were considered eligible for cisplatin-based NAC if they had muscle-invasive bladder cancer, adequate renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m²), acceptable functional capacity, and no contraindications such as severe cardiac dysfunction, uncontrolled infection, or significant hearing impairment. Patients who were medically unfit, who did not want to wait more for RC because of NAC (declined chemotherapy), or had contraindications to cisplatin were assigned to the RC alone group (3). Those in the NAC cohort were treated with either the GC regimen or the MVAC regimen (methotrexate, vinblastine, adriamycin, and cisplatin), each administered for four cycles prior to surgery. The interval between the completion of chemotherapy and RC did not exceed six weeks for any patient.
The demographic (age, gender and body mass index [BMI], preoperative (previous surgery history, intravesical treatment history, neoadjuvant chemotherapy history, concomitant malignancy, presence of ascites, presence of hydronephrosis, smoking status, American Society of Anesthesiologists classification [ASA] score, functional capacity, T stage, grade, clinical lymph node positivity, hemoglobin, white blood cell [WBC], serum creatine, blood nitrogen urea, serum albumin, sodium and potassium levels, comorbidities), intraoperative (operation duration, incision length, urinary diversion technique, length of bowel segment used in urinary diversion, amount of bleeding,) and postoperative (amount of blood transfusion, duration of total parenteral nutrition administration, hospitalization, time to oral nutrition, ureteral catheterization duration, complications, pathological T stage, pathological N stage) characteristics of patients were collected from hospital database. The patients were divided into two groups according to the administration of neoadjuvant chemotherapy. The comparison was made between the two groups in terms of perioperative outcomes.
Postoperative complications were evaluated according to the Clavien–Dindo classification system (8). Preoperative T stage was determined based on the pathological findings of TURBT in conjunction with preoperative imaging. Tumor grade was assessed exclusively according to TURBT pathology (9). Postoperative complications were evaluated within 30 days after surgery according to the Clavien–Dindo classification system (8). Tumor staging was determined based on the current TNM classification of bladder cancer (9).
Statistical Analysis
Data coding and statistical analyses were performed on the computer using the SPSS 22 software package program (IBM SPSS Statistics, IBM Corporation, Chicago, IL). The normality of the variables was assessed using the Shapiro–Wilk test. Variables with a normal distribution were expressed as mean ± standard deviation, while non-normally distributed variables were expressed as median (interquartile range). For non-categorical variables, the independent samples t-test or Mann–Whitney U test was used. For categorical variables, the Chi-square test or Fisher’s exact test was used. To address potential baseline disparities arising from the non-randomized study design, propensity score matching (PSM) was employed. Based on the calculated propensity scores, patients undergoing radical cystectomy (RC) alone were paired with those receiving RC plus NAC in a 1:1 ratio using the nearest-neighbor matching algorithm in terms of age, BMI, previous surgery history, ASA score, preoperative T stage, hemoglobin, WBC, incision length and urinary diversion technique. The balance of matched covariates was evaluated through standardized mean differences (SMDs), with an SMD below 0.10 considered to indicate adequate balance between groups. Cases with a p-value below 0.05 were considered statistically significant.
MATERIALS AND METHODS
Data from 386 patients who underwent RC and ileal loop diversion for urothelial carcinoma between February 2019 and May 2025 were retrospectively analyzed. All procedures were performed by urooncologists with at least 10 years of experience in major oncologic surgery and a minimum annual volume of ten radical cystectomies at a high-volume tertiary cancer center, with the choice of surgical technique left to the discretion of the operating surgeon. Each patient underwent an extended pelvic lymph node dissection.
Sixty-nine patients with insufficient data or a diagnosis of non-urothelial bladder cancer were excluded from the study. The data of 317 patients were included in the study. The Institutional Review Board of Ankara Bilkent City Hospital approved this study (TABED1/1513/2025, Date: 2025-10-22).
Before undergoing RC, every patient received a preoperative TURBT. Subsequently, comprehensive staging with total-body computed tomography (CT) was carried out for staging.
Following diagnostic evaluation, patients were referred to a medical oncologist for cisplatin-based NAC. Eligibility for NAC was determined by a multidisciplinary team including urooncologists and medical oncologists according to contemporary guideline recommendations. Patients were considered eligible for cisplatin-based NAC if they had muscle-invasive bladder cancer, adequate renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m²), acceptable functional capacity, and no contraindications such as severe cardiac dysfunction, uncontrolled infection, or significant hearing impairment. Patients who were medically unfit, who did not want to wait more for RC because of NAC (declined chemotherapy), or had contraindications to cisplatin were assigned to the RC alone group (3). Those in the NAC cohort were treated with either the GC regimen or the MVAC regimen (methotrexate, vinblastine, adriamycin, and cisplatin), each administered for four cycles prior to surgery. The interval between the completion of chemotherapy and RC did not exceed six weeks for any patient.
The demographic (age, gender and body mass index [BMI], preoperative (previous surgery history, intravesical treatment history, neoadjuvant chemotherapy history, concomitant malignancy, presence of ascites, presence of hydronephrosis, smoking status, American Society of Anesthesiologists classification [ASA] score, functional capacity, T stage, grade, clinical lymph node positivity, hemoglobin, white blood cell [WBC], serum creatine, blood nitrogen urea, serum albumin, sodium and potassium levels, comorbidities), intraoperative (operation duration, incision length, urinary diversion technique, length of bowel segment used in urinary diversion, amount of bleeding,) and postoperative (amount of blood transfusion, duration of total parenteral nutrition administration, hospitalization, time to oral nutrition, ureteral catheterization duration, complications, pathological T stage, pathological N stage) characteristics of patients were collected from hospital database. The patients were divided into two groups according to the administration of neoadjuvant chemotherapy. The comparison was made between the two groups in terms of perioperative outcomes.
Postoperative complications were evaluated according to the Clavien–Dindo classification system (8). Preoperative T stage was determined based on the pathological findings of TURBT in conjunction with preoperative imaging. Tumor grade was assessed exclusively according to TURBT pathology (9). Postoperative complications were evaluated within 30 days after surgery according to the Clavien–Dindo classification system (8). Tumor staging was determined based on the current TNM classification of bladder cancer (9).
Statistical Analysis
Data coding and statistical analyses were performed on the computer using the SPSS 22 software package program (IBM SPSS Statistics, IBM Corporation, Chicago, IL). The normality of the variables was assessed using the Shapiro–Wilk test. Variables with a normal distribution were expressed as mean ± standard deviation, while non-normally distributed variables were expressed as median (interquartile range). For non-categorical variables, the independent samples t-test or Mann–Whitney U test was used. For categorical variables, the Chi-square test or Fisher’s exact test was used. To address potential baseline disparities arising from the non-randomized study design, propensity score matching (PSM) was employed. Based on the calculated propensity scores, patients undergoing radical cystectomy (RC) alone were paired with those receiving RC plus NAC in a 1:1 ratio using the nearest-neighbor matching algorithm in terms of age, BMI, previous surgery history, ASA score, preoperative T stage, hemoglobin, WBC, incision length and urinary diversion technique. The balance of matched covariates was evaluated through standardized mean differences (SMDs), with an SMD below 0.10 considered to indicate adequate balance between groups. Cases with a p-value below 0.05 were considered statistically significant.