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Cystectomy

Procedure overview

A cystectomy is a major surgery to remove the bladder, and is most frequently used to treat cancer. A radical cystectomy removes the whole bladder along with surrounding fat and organs. In men, usually the prostate, seminal vesicles and ends of the ureters are removed and sometimes part of the urethra (called a radical cystoprostatectomy). In women, the uterus, cervix, fallopian tubes, ovaries, front wall of the vagina and urethra may be removed (called an anterior pelvic exenteration). A partial cystectomy (also called segmental cystectomy) removes only part of the bladder (with the tumour). It is called bladder-preserving surgery because the bladder is kept in place so you can continue to urinate normally. A partial cystectomy is not commonly done for bladder cancer. 

In an open radical cystectomy, surgeons remove the entire bladder through a long incision (cut) in the abdomen (belly area). The bladder is removed along with surrounding lymph nodes. The surgeon then reconstructs the urinary tract so urine can move out of the body.

Robotic assisted cystectomy is a less invasive method that uses smaller incisions in the abdomen. Surgeons are able to guide the instruments in the body, and have the ability to conduct precise movements allowing minimal trauma to the body.

Depending on how the cancer has advanced, it is necessary to remove parts of the reproductive system (including the prostate, seminal vesicles in men; cervix, ovaries, fallopian tubes, uterus, part of the vaginal wall in women).

cystectomy2
Figure 1. Open vs Robotic, Port Placement for Radical Cystectomy

Learn more about what robotic assisted surgery is and how surgeons use the technology here.


Potential Benefits​

Reported benefits of robotic assisted cystectomy surgery include:

  • Patients less likely to experience blood transfusion[3],[4], and likely to have shorter length of hospital stay.[3],[4]
  • Equivalent 2 year survival compared with open surgery[4]

Additional Patient Resources

Visit the Canadian Cancer Society for more informational about the disease, diagnosis, treatment options and support available.

Community Groups

Educational Videos

Dr. Girish Kulkarni of The Princess Margaret Cancer Centre performed a new robotic cystectomy for a patient with bladder cancer.

 

Risks & Considerations

Not everyone is a candidate for robotic assisted procedures, and other treatment options may be available and appropriate. Only a doctor can determine whether robotic assisted surgery is appropriate for a patient’s situation. Surgery of any form contains risks and it is important to discuss risks with your provider. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Patients have also developed support areas where they are able to speak with each other about the surgery, their experiences, and any issues that they have faced during their treatment. To learn more check out the additional resources above or visit the community section of this website.

[1] https://www.cancer.ca/en/cancer-information/cancer-type/prostate/treatment/?region=on

[2] https://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/surgery/?region=on

[3] Aboumarzouk, Omar M, et al. “Robotic versus Open Radical Cystectomy for Bladder Cancer in Adults.” Cochrane Database of Systematic Reviews, 9 Oct. 2015, 10.1002/14651858.cd011903. Accessed 18 Jan. 2021.

[4] Sathianathen, Niranjan J., et al. “Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis.” Journal of Urology, vol. 201, no. 4, Apr. 2019, pp. 715–720, 10.1016/j.juro.2018.10.006.

[5] Parekh, Dipen J., et al. “Robot-Assisted Radical Cystectomy versus Open Radical Cystectomy in Patients with Bladder Cancer (RAZOR): An Open-Label, Randomised, Phase 3, Non-Inferiority Trial.” Lancet (London, England), vol. 391, no. 10139, 23 June 2018, pp. 2525–2536, pubmed.ncbi.nlm.nih.gov/29976469/, 10.1016/S0140-6736(18)30996-6.