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

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. 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. 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 m 2 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. 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.