Determining the optimal time for radical cystectomy after neoadjuvant chemotherapy

Mmeje, Chinedu O.; Benson, Cooper; Nogueras‐González, Graciela M.; Jayaratna, Isuru; Gao, Jianjun; Siefker-Radtke, Arlene; Kamat, Ashish M.; Dinney, Colin P.; Navai, Neema; Shah, Jay B.

doi:10.1111/bju.14211

Cited by 32 publications

(17 citation statements)

References 27 publications

(37 reference statements)

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“…MIBC can be missed and understaging can reach up to 50% of cases [18]. Delaying cystectomy for MIBC by 90 days may cause an increase of the pN + rate [19], a decrease of the overall survival and progression-free survival [20,21]. High risk prostate cancer biochemical recurrence rates may be higher in patients if definitive treatments are delayed, but there is not a clear cut-off time for this treatment benefit [22,23,24].…”

Section: Discussionmentioning

confidence: 99%

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Safety of urologic elective surgery in a Covid-hospital: our experience in Milan

Blezien

Signorini

Guzzo

et al. 2020

Preprint

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Purpose To demonstrate safety of a new internal protocol for patients and health workers adopted for elective urologic surgical activity during COVID-19 pandemic.Methods From March 9 to April 24, 2020 we have retrospectively evaluated 62 patients who underwent elective surgery in the urology department of IRCCS Policlinico San Donato which became a COVID-hospital. We identified non-deferrable patients that needed to be treated within one month. All patients followed a dedicated pathway from the day-hospital till the discharge. Clinical data, nasopharyngeal swabs, chest X-ray, type of anaesthesia, surgical procedure and days of hospitalization were collected. All patients were interviewed 14 days after surgery to check any Covid-related complications.Results The population included 48 (77.42%) men and 14 (22.58%) women, aged between 17 and 88 years old. We performed sixty-four (64) preoperative screenings and two (2) patients were excluded. 47 (75.81%) patients underwent oncological procedures while 15 (24.19%) patients underwent non-oncological surgery. The average hospitalization time was 2.39±2.21 days.After at least 14 postoperative days (25.00±10.35 days), we interviewed all patients to check their conditions. No patients showed symptoms related to COVID-19, except for 2 (3.23%) who manifested coryza, 28 and 35 days after discharge respectively. Neither patients nor hospital workers developed COVID-19 infection.Conclusion The duration of pandemic period is undefined; therefore, our protocol could be considered a good model for every type of surgery and its application could ensure a continuous treatment for non-deferrable conditions, in a safe way for both the patients and health workers.

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Section: Discussionmentioning

confidence: 99%

“…At the end of December 2019, Wuhan (China) became the centre of an outbreak of pneumonia of an unknown aetiology, called "Coronavirus disease 2019" (COVID- 19), triggered by SARS-CoV-2. In a quite short time, it rapidly spreads worldwide, reaching Europe and the USA [1].…”

Section: Introductionmentioning

confidence: 99%

Safety of urologic elective surgery in a Covid-hospital: our experience in Milan

Blezien

Signorini

Guzzo

et al. 2020

Preprint

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“…Lorsqu'une chimiothérapie néoadjuvante a été effectuée, la CT doit être réalisée dans les 12 semaines postchimiothérapie. Le retard au traitement chirurgical a été associé à une augmentation du risque de dissémination ganglionnaire (pN+) [14] et diminution de la survie sans progression métastatique et de la survie globale des patients [15].…”

Section: Cystectomie Totale (Ct)unclassified

Recommandations CCAFU sur la prise en charge des cancers de l’appareil urogénital en période d’épidémie au Coronavirus COVID-19

Méjean

Rouprêt

Rozet

et al. 2020

Progrès en Urologie

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Pages 11 2 A. Méjean et al. Résultats. -La prise en charge médicale et chirurgicale des patients atteints de cancers de l'appareil urinaire et génital masculin doit être adaptée en modifiant les modalités de consultation, en priorisant les interventions en fonction du pronostic intrinsèque des cancers en tenant compte des comorbidités du patient. La protection des urologues vis-à-vis du COVID-19 doit être prise en considération. Conclusion. -Le CCAFU émet un avis d'experts quant aux mesures à prendre pour adapter la prise en charge des cancers de l'appareil urinaire et génital masculin au contexte de pandémie par COVID-19. Summary Aim. -The French population is facing the COVID-19 pandemic and the health system have been reoriented in emergency for the care of patients with coronavirus. The management of cancers of the urinary and male genital tracts must be adapted to this context. Material and method. -An expert opinion documented by a literature review was formulated by the Cancerology Committee of the French Association of Urology (CCAFU). Results. -The medical and surgical management of patients with any cancers of the urinary and male genital tracts must be adapted by modifying the consultation methods, by prioritizing interventions according to the intrinsic prognosis of cancers, taking into account the patient's comorbidities. The protection of urologists from COVID-19 must be considered. Conclusion. -The CCAFU issues an expert opinion on the measure to be taken to adapt the management of cancers of the male urinary and genital tract to the context of pandemic by COVID-19.

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“…Following NAC, local definitive therapy should occur within 4-6 weeks if possible. Up to 10 weeks between NAC and RC should represent the maximal target time interval limit, as longer intervals may compromise survival outcomes [106][107][108][109].…”

Section: Neoadjuvant Chemotherapy (Nac)mentioning

confidence: 99%

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

Jiang

North

Canil

et al. 2020

BLC

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BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.

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Determining the optimal time for radical cystectomy after neoadjuvant chemotherapy

Abstract: Patients treated with NAC for bladder cancer can undergo RC between 18 and 84 days (2.5-12 weeks) after NAC with no difference in the risk of perioperative morbidity. Delaying surgery beyond 12 weeks was associated with a significant risk of lymph node metastasis.

Cited by 32 publications

References 27 publications

Safety of urologic elective surgery in a Covid-hospital: our experience in Milan

Safety of urologic elective surgery in a Covid-hospital: our experience in Milan

Recommandations CCAFU sur la prise en charge des cancers de l’appareil urogénital en période d’épidémie au Coronavirus COVID-19

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

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