Are the Role of Surgery and its Complications Sufficiently Focused in the Era of Perioperative Systemic Treatments? (European Urology)

Radical cystectomy with pelvic lymph node (LN) dissection is currently considered an effective treatment option for patients with T2-4a N0-2 muscle-invasive bladder cancer (MIBC). Unfortunately, in spite of having clinically localized disease and surgery with curative intent, approximately half of patients experience tumor progression and have very poor prognosis. Analysis of the features of treatment failure reveals that approximately 60-80% of recurrences appear in distant side. Even for patients with organ-confined LN-negative tumors, Hautmann et al [1] observed distant metastases in 9.5% of cases without perioperative chemotherapy.