Studying the impact of comorbidity on post radical cystectomy survival: have we come a full circle?

Radical cystectomy for bladder cancer in Sub-Saharan Africa: techniques, challenges, and survival outcomes: a comprehensive review

Radical cystectomy (RC) with urinary diversion remains the gold-standard treatment for muscle-invasive bladder cancer (MIBC), yet its implementation in Sub-Saharan Africa is hindered by late-stage presentation, limited surgical expertise, and inadequate perioperative care. These challenges contribute to higher morbidity and poorer survival outcomes compared to high-income regions. Additionally, the high prevalence of schistosomiasis-associated squamous cell carcinoma, disparities in multidisciplinary cancer care, and the burden of comorbidities further complicate treatment.This review examines RC techniques practiced in Africa, from open to minimally invasive approaches, assessing their feasibility within resource-limited settings. It explores challenges specific to the region, highlighting the impact of infrastructure gaps, limited access to neoadjuvant and adjuvant therapies, and variations in surgical training. Addressing these barriers requires urgent investment in oncology infrastructure, expanded access to multimodal therapy, and early detection strategies. Optimizing perioperative management and promoting cost-effective urinary diversion techniques are critical to improving bladder cancer outcomes in the region.

Psoas Muscle Mass can Predict Postsurgical Outcomes in Patients Who Undergo Radical Cystectomy and Urinary Diversion Reconstruction

OBJECTIVE

To morphometrically measure to muscle mass which may reflect physical components of frailty. Hence, we evaluated the association between L4 total psoas area (TPA) and operative outcome after radical cystectomy (RC) for bladder cancer.

METHODS

In a retrospective single-center study, bladder cancer patients who underwent RC and urinary diversion between 2007 and 2012 were enrolled. TPA was evaluated in the cross-sectional imaging. The psoas muscles were normalized with the height. Male patients with a psoas mass index ≤7.4 cm²/m² and female patients with a psoas mass index ≤5.2 cm²/m² were classified as sarcopenic. Outcome measures were 30- and 90-day readmission and complications, and survival. Multivariable logistic and Cox proportional-hazards regression models were used to determine relevant predictors.

RESULTS

The median age of the 441 participants and follow up time was 68 years (IQR 59-75) and 1.2 years (IQR 0.5-1.9), respectively. One hundred forty-three patients (32.4%) were sarcopenic. The 30-day readmission and the complication rates were 13.8% and 44.7%, respectively. The 90-day readmission and complication rates were 23.9% and 53.1%, respectively. The 1-year mortality rate was 11.6% (95%CI 8.7-15.4). Multivariable logistic regression analysis revealed an association between increased TPA and lower odds of 30-day complications after RC (OR 0.95, 95%CI 0.92-0.99, P = .02); similarly, an increase in TPA was of prognostic value, although not statistically significant in the multivariable model (P = .05) once adjusting for other patient factors.

CONCLUSION

Sarcopenia predicted early complications and showed an informative trend for overall survival after RC, and thus may inform models predicting postsurgical outcomes.