Editor’s Note: The 9th West China Urologic Oncology Tianfu Academic Conference and the 11th Annual Academic Meeting on Urologic and Male Genitourinary Tumors of the Sichuan Anti-Cancer Association were recently held successfully in Chengdu, Sichuan. Centered on urologic and male genitourinary malignancies, the conference emphasized timeliness and diversity, combining a global perspective with Chinese clinical realities to build a high-level platform for academic exchange and innovation in urologic oncology. During the meeting, Oncology Frontier – Urology Frontier invited Academician Xu Zhang from The Third Medical Center, Chinese PLA General Hospital to share his insights on China’s distinctive achievements in minimally invasive surgery, recent advances in systemic therapy, and their clinical value.01
Oncology Frontier – Urology Frontier
Question: At the conference, you presented a technique known as “anterior-approach radical prostatectomy with preservation of pelvic floor structures.” Compared with traditional procedures, what are the key conceptual and technical innovations of this approach?
Academician Xu Zhang: Today, cancer treatment has entered an era of minimally invasive and precision medicine. In the past, surgical approaches were relatively crude, with the sole objective of completely removing the tumor. Now, while ensuring oncologic radicality, we place far greater emphasis on preserving patient function and improving postoperative quality of life.
Taking prostate cancer surgery as an example, our goals extend beyond tumor eradication. We aim to minimize surgical complications—such as massive bleeding—and to improve postoperative urinary continence. Historically, the incidence of postoperative urinary incontinence exceeded 20%, severely affecting patients’ daily lives and psychological well-being. Preservation of sexual function is also a critical consideration.
Surgical techniques themselves have evolved continuously. Traditional anterior-approach procedures often cause substantial disruption to pelvic floor structures and frequently rely on electrocautery, which can lead to additional tissue damage. By contrast, the posterior approach proposed by the Italian surgeon Professor Bocciardi offers better preservation of the bladder neck and anterior structures. However, this technique is technically demanding, limited by a narrow operative field, and difficult to popularize. Moreover, inadequate visualization may increase the risk of positive surgical margins, raising concerns about incomplete tumor resection.
To address these challenges while retaining the advantages of the posterior approach, we developed a simpler and more practical method: performing the entire prostatectomy through a small incision at the bladder neck. This “anterior-approach radical prostatectomy with preservation of pelvic floor structures” allows effective tumor removal while maximizing preservation of normal anatomy.
Our philosophy is grounded in the belief that the human body inherently provides multiple natural pathways to address disease. As surgeons, our task is to identify and utilize these pathways. This innovative minimally invasive approach adheres strictly to anatomical principles, employs blunt dissection between fascial planes, and minimizes the use of electrocautery to reduce collateral tissue injury. With only a small bladder-neck incision, the procedure achieves oncologic radicality while preserving pelvic floor integrity. The technique is practical, reproducible, and readily generalizable, with the potential to benefit a broad patient population.
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Oncology Frontier – Urology Frontier
Question: From the international dissemination of the retroperitoneal laparoscopic approach to innovations in robotic anterior approaches, how has Chinese urology transitioned from a “follower” to a “leader”?
Academician Xu Zhang: Over the past two to three decades, surgery has undergone a dramatic transformation. Twenty years ago, operations for renal cancer, bladder cancer, or prostate cancer often required a large abdominal incision—30 cm or more—necessitating direct manual access to the operative field. These procedures were highly invasive and associated with prolonged recovery.
Today, with the advancement of minimally invasive techniques, we have entered a far more precise era. Complex surgeries can now be completed through just a few small ports. High-definition three-dimensional visualization systems allow us to clearly see fine anatomical structures that were previously indistinguishable to the naked eye. Robotic instruments, as delicate and maneuverable as chopsticks, can perform highly refined movements within confined spaces.
In this era of minimally invasive precision medicine, experts worldwide are striving to maximize the potential of new technologies. By integrating detailed anatomical knowledge with pathophysiology and disease mechanisms, surgeons aim to design more scientific and efficient procedures. While Western countries had an earlier start in traditional surgery, China developed minimally invasive techniques almost in parallel—and in some areas achieved a form of “leapfrogging.”
Leveraging extensive clinical experience and in-depth research into diseases with distinct local characteristics, Chinese surgeons have pioneered numerous innovative procedures. These approaches have been validated through rigorous clinical studies and real-world practice. Today, China has trained many world-class urologic surgeons and has attracted international colleagues—including leading experts—to visit, learn, and exchange ideas. Notably, some Chinese-developed techniques have already been incorporated into international guidelines. This marks a milestone in China’s surgical advancement and reflects our growing role in shaping the future direction of the field.
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Oncology Frontier – Urology Frontier
Question: With recent breakthroughs in systemic therapy, how do you view the evolving roles of surgery and other local treatments within the broader context of cancer management?
Academician Xu Zhang: Recent advances in comprehensive cancer treatment in China are truly encouraging. As discussed earlier, Chinese physicians have made remarkable progress in urologic surgery. At the same time, we have also achieved significant breakthroughs in multidisciplinary cancer management.
From early screening of urologic malignancies to pharmacologic treatment, rapid innovation in domestic biopharmaceuticals and medical devices has brought new hope to patients. Taking bladder cancer as an example, China previously relied largely on international standard treatment protocols. Today, however, we have independently developed a range of immune checkpoint inhibitors with efficacy comparable to leading international agents.
Even more notably, China has introduced antibody–drug conjugates targeting HER2, with combination regimens demonstrating efficacy on par with advanced international targeted–immunotherapy combinations. Research findings in this area have been published in The New England Journal of Medicine, marking international recognition of Chinese scholarship and signaling a potential impact on future global guidelines.
Overall, whether in early diagnosis, surgical intervention, or advanced-stage comprehensive management, China continues to make steady progress and demonstrates strong developmental momentum. Looking ahead, we are confident that China will further enhance its capacity for the prevention and treatment of urologic malignancies, ultimately benefiting a greater number of patients worldwide.
Academician Xu Zhang
