Radical Transurethral Resection Alone, Robotic or Partial Cystectomy, or Extended Lymphadenectomy

摘要: The contemporary standard of care for patients with muscle-invasive bladder cancer consists cisplatin-based systemic chemotherapy followed by radical cystectomy and bilateral pelvic lymph node dissection (RC/PLND). For highly selected disease, surgical preservation approaches including transurethral resection (TUR) partial (PC) or without PLND may be reasonable alternatives to RC/PLND. In appropriately patients, these offer comparable oncologic outcomes while avoiding the morbidity surgery urinary diversion. success both TUR PC as bladder-sparing RC/PLND disease requires careful patient tumor selection, well meticulous long-term follow-up. While have been investigated exhibiting clinical response following neoadjuvant chemotherapy, results mixed. Improvements in accuracy staging refinements selection allow improved strategies incorporating PC. The crucial role lymphadenectomy at time RC purposes its possible therapeutic benefit is generally accepted. Many retrospective studies reported an association between greater extent outcomes. However, there no consensus regarding optimal lymphadenectomy. Currently, are reports from prospective, randomized trials address this issue regards cancer-specific overall survival. Forgoing when managing eliminates opportunity eradicate occult regional LN involvement. Future advances our understanding appropriate will require well-designed prospective that directly compare varying extents their ability provide local distant control disease-specific