Is there still a role for radical cystectomy?

Abstract

Radical cystectomy (RC) with lymph node dissection (eLND) and neoadjuvant chemotherapy still represents the standard treatment for very high-risk non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer patients. Radical surgery provides recurrence-free (RFS) and overall survival (OS) rates of 68 and 66% after 5 years and of 60 and 43% after 10 years from RC, respectively. One of the major concerns about radical surgery regards the high morbidity/mortality rates related to the procedure and the consequent decreased patients' quality of life. Therefore, bladder sparing techniques in a multimodal setting have been proposed and investigated, with promising results. However, to date, long-term oncological outcomes provided by bladder sparing techniques are still lacking. Moreover, patients who will not respond to bladder sparing treatments will, anyway, undergo salvage RC. For these reasons, radical surgery still represents the more convincing options since can provide good long-term outcomes and a decreased risk of local/regional recurrence thanks to the eLND. Moreover, RC is indicated also in locally advanced disease as well as in elderly patients. Finally, the possibility to perform an orthotopic neobladder could improve patients' acceptability and quality of life.