European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines

Witjes, J. Alfred; Bruins, Harman Max; Cathomas, Richard; Compérat, Éva; Cowan, Nigel C.; Gakis, Georgios; Hernández, Virginia; Espinós, Estefanía Linares; Lorch, Anja; Neuzillet, Y.; Rouanne, Mathieu; Thalmann, George N.; Veskimäe, Erik; Ribal, María J.; Heijden, Antoine G. van der

doi:10.1016/j.eururo.2020.03.055

Cited by 1,502 publications

(1,420 citation statements)

References 143 publications

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“…There is a large consensus regarding the staging role of PLND during RC, even if its therapeutic role and standard template have yet to be defined [1]. Standard PLND (s-PLND) involves removal of nodal tissue cranially up to the common iliac bifurcation, with the ureter being the medial border, and including the internal iliac, presacral, obturator fossa and external iliac nodes.…”

Section: Open Radical Cystectomy Vs Robot-assisted Radical Cystectomymentioning

confidence: 99%

“…Different types of ICUD PSM: positive surgical margins; LNc: lymph node count; DFS: disease free survival; CSS: cancer specific survival; OS: overall survival. 1 2-yr follow-up; 2 1-yr follow-up; 3 5-yr follow-up; NA: not available have been reported such as: ileal conduit, orthotopic neobladder and continent cutaneous diversion. EAU guidelines underlines that although an intracorporeal neobladder is a more complex procedure, the choice of urinary diversion must not depend on the surgical approach [1].…”

Section: Intracorporeal Vs Extracorporeal Robot-assisted Urinary Divementioning

confidence: 99%

“…BC is the 7th most commonly diagnosed cancer in males, and the 11th when both genders are considered. In the European Union, the age-standardised incidence rate is 19.1 for men, and 4.0 for women [1]. In Italy, in 2017 it has reported 27,000 new diagnosis of BC (21,700 for men and 5,300 for women), in particular at diagnosis 70% of patients has a non-invasive BC while 30% of patients has a muscle-invasive disease [2].…”

Section: Introductionmentioning

confidence: 99%

“…Radical cystectomy (RC) and pelvic lymph node dissection (PLND) with urinary diversion (UD) still remains the gold standard treatment for non-metastatic muscle invasive bladder cancer (MIBC) and for recurrent non-muscle invasive disease [1]. Actually, it is growing the literature about multimodality treatment (MMT) or trimodality treatment combines TURB, chemotherapy and radiation.…”

Section: Introductionmentioning

confidence: 99%

“…The evidences supporting a bladdersparing approach to treat BC are few, and the impact of MMT, as compared to RC, on long-term overall survival (OS) remains undefined. As a result, MMT could be offered as an alternative in highly selected patient population, especially for whom cystectomy is not an option [1,3,4]. Therefore, many patients continue to be offered radical surgery as the standard-of-care treatment.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Robot-assisted radical cystectomy: state of art and future perspectives

Mastroianni¹,

Simone²

2019

ann urol oncol

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Bladder cancer (BC) remains one of the most common cancer worldwide. Radical cystectomy (RC) and pelvic lymph node dissection (PLND) with urinary diversion (UD) is still considered the gold standard treatment for non-metastatic muscle invasive bladder cancer (MIBC) and for recurrent non-muscle invasive disease. The open approach remains the reference option of treatment for RC, even if robotic surgery is rapidly increasing. Nowadays, several studies have reported perioperative, functional and oncological outcomes of robot-assisted radical cystectomy (RARC), but data are still immature to compare both procedures. All the current randomized controlled trials (RCTs), did not prove any significant difference between open RC and RARC, underlining no superiority between both procedures. Therefore, RARC is still considered an investigational procedure. On the other hand, modern robotic surgical practice has been evolved by the introduction of innovative technologies. The technological progress is improving, in particular in robotic surgery, offering several future perspectives, such as the ICG technique. The aim of the review is to describe the state of art, and to outline future perspectives of RARC, in order to establish the role of robotic surgery in the complex field of radical cystectomy.

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Section: Open Radical Cystectomy Vs Robot-assisted Radical Cystectomymentioning

confidence: 99%

Section: Intracorporeal Vs Extracorporeal Robot-assisted Urinary Divementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Robot-assisted radical cystectomy: state of art and future perspectives

Mastroianni¹,

Simone²

2019

ann urol oncol

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Bladder Cancer

Lenis

Lec

Chamie³

et al. 2020

JAMA

1,145

812

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ImportanceBladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality.ObservationsAdvanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non–muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non–muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease.Conclusions and RelevanceImproved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non–muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.

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Effect of Robot-Assisted Radical Cystectomy vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer—Reply

Catto

Khetrapal

Ambler

2022

JAMA

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In ReplyIn their Letter about our recent study 1 of patients with asymptomatic severe carotid stenosis, Dr Sterpetti and colleagues highlight the short life expectancy of the cohort and state that only 43 patients were alive at the end of the study. We would like to clarify that this number applies only to the small subgroup of patients who experienced an ipsilateral stroke and survived through the observation period. Overall mortality of the cohort was 51.4% during the study period. We agree with Sterpetti and colleagues that surgically and medically treated patients were likely not comparable; indeed, we specifically avoided any such comparison in this descriptive study and cautioned against extrapolating our findings in an attempt to make this association.Dr Huang and colleagues inquire about subanalyses regarding medication adherence according to intervention status. As a descriptive study, we deliberately avoided comparison between carotid intervention and no-intervention groups. However, we anticipated this question and included information in the online Supplement about medication adherence in patients who did not undergo surgical intervention. Because the surgical intervention group was not a focus of our study, data about medication adherence for these patients were not included. We point readers to a different publication 2 that documents the outcome of patients undergoing carotid intervention during a similar time; this publication includes medication adherence and stroke outcomes.Dr Paraskevas inquires whether stroke rates in our study may have been obscured by lack of data regarding cause of death. If a stroke was a clinically registered event in the Kaiser Permanente Northern California health system, it was accounted for in the primary outcome, even if there was an associated death. We were less likely to have cause-of-death information for deaths occurring outside our health system, and the cause of death for some events was not available. Paraskevas also asks if it would be possible to understand the reasons why some patients did or did not undergo intervention. This is an established limitation of our study, but also speaks to the broader nature of our real-world observational cohort. We captured all patients in our health system with relevant carotid pathology, not just those referred to a specialty clinic-the latter being the more common, but selective, method of reporting in the medical literature. Although we were able to review specialty consultation notes regarding treatment preferences, this information was not available for many patients and was therefore not included in our study. We agree that if patients in this cohort were at high risk of stroke but also had a high overall mortality, this may have led to a lower observed stroke rate. However, we used a competing-risks model to generate the reported estimates. This phenomenon highlights the high-risk nature of patients with vascular disease and emphasizes the importance of patient selection when considering an intervention for a proph...

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European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines

Cited by 1,502 publications

References 143 publications

Robot-assisted radical cystectomy: state of art and future perspectives

Robot-assisted radical cystectomy: state of art and future perspectives

Bladder Cancer

Effect of Robot-Assisted Radical Cystectomy vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer—Reply

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