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Updated: Oct 21, 2025
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Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction
Published on: January 3, 2020
16.9K
[NEOADJUVANT CHEMOTHERAPY BEFORE RADICAL CYSTECTOMY - MIGHT IT BE OFFERED SELECTIVELY?]
Hemda Luwisch1, Igal Rabinovich1, Vladimir Yutkin1
1Department of Urology, Hadassah University Hospital, Jerusalem.
Harefuah
|September 5, 2021
Summary
Older age, comorbidity, and large tumor diameter predict recurrence risk after bladder cancer surgery. However, these factors are not sufficient for clinical decisions, so neoadjuvant chemotherapy remains standard for all patients.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Neoadjuvant chemotherapy before radical cystectomy is standard for muscle-invasive bladder cancer to treat micrometastases.
- Many patients do not develop metastases and receive unnecessary chemotherapy.
- Identifying pre-operative risk factors can help triage patients for neoadjuvant therapy.
Purpose of the Study:
- To identify pre-operative risk factors for developing metastases after radical cystectomy.
- To determine if patient characteristics can predict recurrence risk in muscle-invasive bladder cancer.
Main Methods:
- A retrospective study of 285 patients who underwent radical cystectomy without neoadjuvant chemotherapy from 1998 to 2018.
- Median follow-up was 42.5 months, with 99 patients (34%) developing recurrence.
- Comparison of 10 pre-operative parameters between patients who did and did not develop recurrence.
Main Results:
- Increased recurrence risk was associated with older age (p=0.045), high Charlson Comorbidity Index (p=0.003), and large tumor diameter (p=0.01).
- No significant differences in recurrence were found based on gender, tumor type, stage, histological variant, hydronephrosis, CIS, or sarcomatoid differentiation.
Conclusions:
- Older age, comorbidity, and large tumor diameter are predictors of recurrence after radical cystectomy for bladder cancer.
- These factors alone are insufficient for clinical decision-making regarding neoadjuvant chemotherapy.
- Current standard of care recommends neoadjuvant chemotherapy for all radical cystectomy candidates, pending future molecular markers for risk stratification.
