Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systemat
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ORIGINAL ARTICLE
Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta‑analysis Victor M. Schuettfort1,2 · Benjamin Pradere1,3 · Fahad Quhal1,4 · Hadi Mostafaei1,5 · Ekaterina Laukhtina1,6 · Keiichiro Mori1,7 · Reza Sari Motlagh1 · Margit Fisch2 · David D’Andrea1 · Michael Rink2 · Paolo Gontero8 · Francesco Soria8 · Shahrokh F. Shariat1,6,9,10,11,12 Received: 13 July 2020 / Accepted: 31 August 2020 © The Author(s) 2020
Abstract Objective We conducted a systematic review and meta-analysis to assess the available literature regarding the surgical and oncologic outcomes of patients undergoing salvage radical cystectomy (SV-RC) for recurrence or failure of bladder sparing therapy (BST) for muscle-invasive bladder cancer (MIBC). Methods We searched MEDLINE (PubMed), EMBASE and Google Scholar databases in May 2020. We included all studies of patients with ≥ cT2N0/xM0 bladder cancer that were eligible for all treatment modalities at the time of treatment decision who underwent BST including radiotherapy (RTX). A meta-analysis was conducted to calculate the pooled rate of several variables associated with an increased need for SV-RC. Study quality and risk of bias were assessed using MINORS criteria. Results 73 studies comprising 9110 patients were eligible for the meta-analysis. Weighted mean follow-up time was 61.1 months (range 12–144). The pooled rate of non-response to BST and local recurrence after BST, the two primary reasons for SV-RC, was 15.5% and 28.7%, respectively. The pooled rate of SV-RC was 19.2% for studies with a follow-up longer than 5 years. Only three studies provided a thorough report of complication rates after SV-RC. The overall complication rate ranged between 67 and 72% with a 30-day mortality rate of 0–8.8%. The pooled rates of 5 and 10-year disease-free survival after SV-RC were 54.3% and 45.6%, respectively. Conclusion Approximately one-fifth of patients treated with BST with a curative intent eventually require SV-RC. This procedure carries a proportionally high rate of complications and is usually accompanied by an incontinent urinary diversion. Keywords MIBC · Bladder sparing treatment · Bladder · Cancer · Salvage cystectomy · Radiotherapy
Introduction Data from large meta-analyses suggest that bladder sparing therapy (BST) could offer equal oncologic outcomes compared to radical cystectomy (RC) in well-selected patients with muscle-invasive bladder cancer (MIBC) [1–3]. The most effective BST strategy consists of maximal transurethral resection of bladder tumor (TURBT) followed by Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03436-0) contains supplementary material, which is available to authorized users. * Shahrokh F. Shariat [email protected] Extended author information available on the last page of the article
radiochemotherapy (RCT) [4]. This treatment strategy was primarily used for the elderly, frail patients who
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