Which Patients Should Undergo Immediate or Deferred Cystectomy in Non-Muscle Invazive Bladder Cancer? Evaluation of Selection Criteria

Abstract

Bladder cancer is the most common malignancy of the urinary tract in Europe. 70% of all muscle invasive is bladder cancer (MIBC) at the time of diagnosis whereas remaining 30% is non-muscle invasive bladder cancer (NMIBC). NMIBC patients with low-risk can be treated with complete transurethral resection of bladder tumor (TUR-BT) and perioperative single-dose adjuvant chemotherapeutic instillation; whilst TUR-BT and bacille calmette guerin (or mitomycin) treatment are usually used in patient management with high-risk tumor. Radical cystectomy may be the choice of treatment in high-risk NMIBC. Although radical cystectomy is the definitive treatment of MIBC, its role and timing in NMIBC is still remains unclear. Early and deferred cystectomy refers two different cystectomy concepts in NMIBC without a definitive time threshold. Early cystectomy defines cystectomy in a short time span following pathologic diagnosis, whereas cystectomy performed after bladder-sparing surgery is a deferred cystectomy. Despite the difference between these studies in regard to design and outcomes, most of the conducted studies have shown immediate cystectomy to be superior to deferred cystectomy with favorable survival rates. According to previous studies and a meta-analysis, depth of invasion in lamina propria and presence of carcinoma in situ have shown to be the most significant factors supporting immediate cystectomy. Increased knowledge and surgical experience, the advantages of robotic surgery as well as orthotopic urinary diversions being used more common are some factors which may encourage clinicians and patients in decision making for an early cystectomy with functional and aesthetic advantages.