Ten-year oncological and renal outcomes after radical cystectomy with orthotopic neobladder reconstruction.

BACKGROUND: Radical cystectomy (RC) with orthotopic neobladder (ONB) reconstruction provides oncological control and quality-of-life benefits for selected patients with bladder cancer. However, prognostic factors for recurrence remain to be elucidated. Herein, we evaluated 10-year oncological and renal functional outcomes after ONB reconstruction at a single institution. METHODS: We retrospectively reviewed 84 patients who underwent RC with ONB reconstruction at our institution between June 2009 and August 2024. We analyzed clinicopathological characteristics, perioperative variables, and postoperative outcomes. RESULTS: All patients were male, the median age was 68 (range, 45-82) years, and the median follow-up was 79 months (range, 4-179). The 5- and 10-year recurrence-free survival (RFS) rates were 76% and 72%, and the 5- and 10-year cancer-specific survival rates were 92% and 83%, respectively. In univariate analysis, postoperative nodal status, adjuvant chemotherapy, and postoperative T status were significantly associated with RFS. Multivariate analysis identified postoperative T status as the only independent predictor (HR 2.976, 95% CI 1.179-7.5132, p = 0.021). Renal function declined gradually from a mean eGFR of 65.3 ± 15.5 mL/min/1.73 m2 preoperatively to 47.7 ± 14.4 at 10 years. A ≥ 25% renal decline was observed in 28.2% of patients at 1 year. Postoperative hydronephrosis was the only significant risk factor for renal deterioration. CONCLUSIONS: ONB reconstruction after RC provided durable oncological control and acceptable long-term renal function over 10 years. Renal deterioration was primarily associated with postoperative hydronephrosis. These findings support the feasibility of ONB in appropriately selected patients with careful postoperative surveillance.