Clinical outcome of neobladder or augmentation after cystectomy in locally advanced colorectal cancer involving the urinary tract: Case series

Background: In most cases of colorectal cancer (CRC) with bladder invasion, ileal conduit diversion is commonly performed. However, with increasing survival rates, quality of life becomes a significant concern, making this approach less favorable. Thus, this study aims to investigate the clinical outcomes of patients with CRC who underwent neobladder or augmentation surgeries. Methods : We retrospectively reviewed the records of nine patients who underwent neobladder or augmentation surgeries combined with surgical management of locally advanced CRC involving the urinary tract between 2011 and 2018 at Asan Medical Center. Result: Nine patients underwent neobladder or augmentation procedures following extensive cystectomy due to rectal or sigmoid colon cancer. The median age of these patients was 58, ranging from 45 to 71 years. Most of the patients were diagnosed with sigmoid colon cancer, and the bladder was the most commonly affected genitourinary tract organ. Of nine patients, two underwent total cystectomy with neobladder procedures, while seven had partial cystectomy and augmentation due to insufficient residual bladder. Four patients needed ureterectomy because of ureter invasion. Two female patients experienced vesico-vaginal fistula complications. Three out of the nine patients (33%) showed no bladder invasion at the pathological stage. Of the patients, seven achieved full continence while two did not. Conclusion : Quality of life is crucial for CRC patients with improved survival rates. In our study, postoperative mortality or morbidity was not significant among patients who underwent total cystectomy. Neobladder or augmentation surgeries are feasible options for CRC patients with urinary tract invasion.