Evolution of treatment and oncological outcomes in patients undergoing radical cystectomy: a comparative analysis across two decades at a tertiary center.

BACKGROUND

Over the last two decades, significant advances in the perioperative management of muscle-invasive bladder cancer, such as enhanced recovery protocols, increased use of neoadjuvant chemotherapy, improved care pathways, and stronger multidisciplinary collaboration, have reshaped surgical outcomes. This study aimed to evaluate the evolution of care and oncological outcomes in patients undergoing radical cystectomy at a Brazilian tertiary cancer center over 20 years.

METHODS

We retrospectively analyzed clinical, surgical, and pathological data from patients with bladder cancer who underwent radical cystectomy between January 2005 and April 2025. Patients were stratified into two cohorts according to the year of surgery (2005-2014 vs. 2015-2025). Survival analyses were performed using Kaplan-Meier curves to compare overall survival, cancer-specific survival, and recurrence-free survival between periods.

RESULTS

A total of 733 patients were included (mean age, 66.2 years; 69.2% male). An age-adjusted Charlson Comorbidity Index ≥ 3 was present in 90.4%, and preoperative hydronephrosis in 41.5%. Locally advanced disease (pT3-pT4) occurred in 50.9%, lymph node positivity (pN+) in 26.6%, and 34.5% received neoadjuvant chemotherapy. Early complications (< 30 days) occurred in 51.2%, early reoperation in 19.3%, and late complications (30-90 days) in 24.0%, with 33.3% classified as Clavien-Dindo grade ≥ III. On multivariable Cox regression, treatment period remained independently associated with improved overall survival (HR 0.75, 95% CI 0.58-0.97; p = 0.029). Clinical stage was also independently associated with overall survival (overall p = 0.046), with advanced stage increasing the hazard of death (HR 1.48, 95% CI 1.08-2.02; p = 0.015). Kaplan-Meier analysis showed significantly improved overall, cancer-specific, and recurrence-free survival in 2015-2025 versus 2005-2014 (all log-rank p < 0.001).

CONCLUSION

Improved survival after radical cystectomy over the last decade reflects advances in perioperative care in the management of bladder cancer patients undergoing radical cystectomy.