Survival outcomes after radical cystectomy versus conservative management for T1 high grade non-muscle invasive micropapillary bladder cancer: a multicentre collaboration by the European Association of Urology – young academic urologists (EAU-YAU): urothelial carcinoma working group

Background: Radical cystectomy with pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. With the advent of improved surgical techniques and postoperative management, the complications and mortality rates have reduced. The present study was done to analyse the perioperative, early and late compilations following radical cystectomy for bladder tumor.Methods: This is a prospective observational study of patients who underwent radical cystectomy for invasive bladder tumor from February 2016 to November 2017. Radical cystectomy was done through midline transperitoneal approach. Urinary diversion was done by ileal conduit. All patients were followed at 6th week, 3rd month, 6th month, and at 1 year.Results: Total 21 patients underwent radical cystectomy, 17(80.95%) were males and 4 (19.04%) females. The median age was 60 years, ranging from 40 to 73 years. The most common age group was 60 to 75 years (52.3%). Thirteen (61.9%) patients were smokers and all were males. Painless haematuria alone was most common presentation (of bladder tumor) seen in 15 (71.4%) patients. Early complications were seen in 8 (38.09%) patients, most common early complication was urinary leak 2 (9.5%) patents, other early complications were bowel leak, wound dehiscence, pelvic collection, burst abdomen, prolonged ileus, subacute intestinal obstruction, acute kidney injury and sepsis seen in one (4.25%) patient each. Late complications were seen in 4 (19.04%) patients. Pelvic recurrence was the most common late complication seen in 2 (9.55%) patients. Ureteric stricture was seen in one patient (4.75%) for which percutaneous nephrostomy and antegrade DJ stenting was done. Among the histopathological variants of tumor 20 (95.25%) patients had high grade variants and only one (4.75%) had low grade papillary urothelial carcinoma. Among the high grade variants most common pathology was urothelial carcinoma in 17 (80.9%) patients.Conclusions: Radical cystectomy remains the main stay of treatment in muscle-invasive bladder cancer. This is relatively safe procedure with minimal morbidity and mortality.

Download Full-text

Survival Outcomes of Early versus Deferred Cystectomy for High-Grade Non-Muscle-Invasive Bladder Cancer: A Systematic Review

Current Urology ◽

10.1159/000499257 ◽

2020 ◽

Vol 14 (2) ◽

pp. 66-73

Author(s):

Jonathan C. M. Wan

Keyword(s):

Systematic Review ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Treatment Plan ◽

Invasive Bladder Cancer ◽

Survival Outcomes ◽

High Grade ◽

Muscle Invasive Bladder Cancer ◽

Term Survival ◽

Muscle Invasive

Background: Studies report that survival outcomes in patients with non-muscle-invasive bladder cancer (NMIBC) are worse when cystectomy is delayed. However, no systematic evidence is available. Objective: The aim of this study was to systematically review the literature to compare the long-term survival outcomes of patients with high-grade NMIBC (T1G3, including carcinoma in situ) who have early cystectomy compared to deferred radical cystectomy post-diagnosis. Materials and Methods: A systematic review was carried out by searching MEDLINE and related databases (Google Scholar, National Health Service Evidence) for all relevant studies published from 1946 to present. Additional studies were identified through following the references of relevant papers. Studies were included if they met the following criteria: inclusion of at least 30 patients having high-grade NMIBC, 2 groups treated with either early or deferred cystectomy with a clear temporal cut-off between groups and reported data on survival rate of at least 5 years. Results: Literature was systematically reviewed, and 10 studies were included, totaling 1,516 patients who underwent either primary cystectomy or deferred cystectomy. It was found that patients who underwent early cystectomy show improved 5- to 10-year cancer-specific survival (relative risk = 0.81, p = 0.029) suggesting a significant survival benefit when compared to deferred cystectomy. Conclusions: This study provides systematically gathered evidence showing benefit of early cystectomy. Despite this result, radical cystectomy greatly impairs quality of life and represents overtreatment for a significant minority. This result highlights the importance of a decisive treatment plan to minimize treatment delay.

Download Full-text

Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: a multicentre cohort from the european association of urology – young academic urologists (EAU-YAU): urothelial carcinoma working group

European Urology Open Science ◽

10.1016/s2666-1683(21)00942-3 ◽

2021 ◽

Vol 32 ◽

pp. S123

Author(s):

L. Mordasini ◽

C. Lonati ◽

L. Afferi ◽

O. De Cobelli ◽

E. Di Trapani ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Diagnostic Accuracy ◽

Urothelial Carcinoma ◽

Working Group ◽

European Association ◽

Lymph Node Staging ◽

Multicentre Cohort ◽

European Association Of Urology

Download Full-text

Guideline on Muscle-Invasive and Metastatic Bladder Cancer (European Association of Urology Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

Journal of Clinical Oncology ◽

10.1200/jco.2015.65.9797 ◽

2016 ◽

Vol 34 (16) ◽

pp. 1945-1952 ◽

Cited By ~ 108

Author(s):

Matthew I. Milowsky ◽

R. Bryan Rumble ◽

Christopher M. Booth ◽

Timothy Gilligan ◽

Libni J. Eapen ◽

...

Keyword(s):

Bladder Cancer ◽

Clinical Practice ◽

Radical Cystectomy ◽

Clinical Oncology ◽

Combination Chemotherapy ◽

European Association ◽

Metastatic Bladder Cancer ◽

American Society ◽

Muscle Invasive ◽

European Association Of Urology

Purpose To endorse the European Association of Urology guideline on muscle-invasive (MIBC) and metastatic bladder cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. Methods The guideline on MIBC and metastatic bladder cancer was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and recommendations. Results The ASCO Endorsement Panel determined that the recommendations from the European Association of Urology guideline on MIBC and metastatic bladder cancer, published online in March 2015, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorses the guideline on MIBC and metastatic bladder cancer and has added qualifying statements, including highlighting the use of chemoradiotherapy for select patients with MIBC and recommending a preference for clinical trials in the treatment of metastatic disease in the second-line setting. Recommendations Multidisciplinary care for patients with MIBC and metastatic bladder cancer is critical. The standard treatment of MIBC (cT2-T4a N0M0) is neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy. In cisplatin-ineligible patients, radical cystectomy alone is recommended. Adjuvant cisplatin-based chemotherapy may be offered to high-risk patients who have not received neoadjuvant therapy. Chemoradiotherapy may be offered as an alternative to cystectomy in appropriately selected patients with MIBC and in some patients for whom cystectomy is not an option. Metastatic disease should be treated with cisplatin-containing combination chemotherapy or with carboplatin combination chemotherapy or single agents in patients ineligible for cisplatin. Additional information is available at http://www.asco.org/endorsements/MIBC and www.asco.org/guidelineswiki .

Download Full-text