Partial versus radical cystectomy in localized colorectal cancer: a systematic review and meta-analysis

Abstract

Purpose: Locally advanced colorectal tumors frequently invade adjacent organs, particularly the urinary bladder in the sigmoid colon and upper rectum, complicating multivisceral resections. This study compared postoperative outcomes of partial cystectomy (PC) and total cystectomy (TC) in patients with locally advanced colorectal cancer.

Methods: A systematic review was conducted in PubMed, Scopus, Central Register of Clinical Trials, and Web of Science for studies published up to November 2024. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with I² statistics. Statistical analyses were performed in R Software 4.4.1.

Results: Nine retrospective studies including 894 patients were analyzed. Among them, 433 (48.43%) underwent PC, and 461 (51.57%) underwent TC. Compared to TC, PC was associated with significantly lower rates of surgical site infection (OR 0.33; 95% CI 0.13-0.80; p = 0.015), shorter operative time (MD - 169.7 min; 95% CI - 214.1 to - 125.3; p < 0.01), reduced blood loss (MD - 1005.9 ml; 95% CI - 1362.1 to - 649.8; p < 0.01), and shorter hospital stay (MD - 6.6 days; 95% CI - 9.4 to - 3.9; p < 0.01). No significant differences were observed between groups in local or distant recurrence, urinary and intestinal leaks, pelvic abscess, ileus, urinary tract infection, or 90-day mortality.

Conclusion: Partial cystectomy demonstrated superior postoperative outcomes, including fewer surgical site infections, reduced operative time, less blood loss, and shorter hospitalization. Oncological outcomes and other postoperative complications were comparable between PC and TC, supporting PC as a safe and effective option in selected patients.

Keywords: Advanced colorectal cancer; Cystectomy; Neobladder; Urostomy.