Cystectomy in Metastatic Bladder Cancer: Feasibility, Safety and Outcomes

Potential clinical efficacy of cystectomy in patients with metastatic bladder cancer (mBCa) remains poorly investigated. The clinical data suggest that there could be a benefit from the local treatment in selected patients with mBCa in terms of redeeming local symptoms, increasing quality of life (QoL), and decreasing the number of the potential adverse events of systemic therapy. The aim of our study was to test safety and efficacy of cystectomy in mBCa and its impact on patients' survival, QoL, and eligibility for systemic therapy.

Retrospective cross-sectional analysis of 524 patients treated with cystectomy due to bladder cancer in the National Cancer Institute of Ukraine from 2008 to 2019 is presented. We selected a group of 21 (3.6%) patients with surgically resectable primary tumors and advanced metastatic disease prior to the surgery and proceeded for further analysis. Patients were analyzed in terms of pre- and postoperative performance status, metastatic burden, surgical complexity and complications (Clavien-Dindo grade), clinical benefits of systemic therapy, and cancer specific survival.

Six patients underwent preoperative systemic therapy with partial response (n = 4) and stable disease (n = 2) according to RECIST 1.1. There were no severe intraoperative complications, although 2 patients experienced Clavien Grade III events that needed surgical correction in the postoperative period. During the analysis, no 30-day mortality events were found, and 11 of 21 patients were alive 1 year after surgery. Most patients (n = 19) were eligible for standard first-line chemotherapy after surgery, with 13 proceeding to second-line chemotherapy due to further progression with no AE higher than grade II during systemic therapy. An increase in QoL was found out by comparing the questionnaire data before and 3 months after surgery.

The benefits of cystectomy in mBCa setting are mainly hidden by QoL improvement and the decreasing number of the potential contraindications to the systemic therapy. Potential effects that reduce adverse events during chemotherapy should prompt to estimate oncological preferences of cystectomy in advanced bladder cancer.