Does Time to Adjuvant Chemotherapy after Radical Cystectomy Affect Survival in Muscle Invasive Bladder Cancer? A Systematic Review

Abstract

(1) Purpose: To assess the survival benefit for different times to adjuvant chemotherapy after a radical cystectomy. (2) Materials and Methods: We systematically searched PubMed®, Cochrane Central®, Scopus®, and Web of Science® library databases for original articles that looked at timing to adjuvant chemotherapy after radical cystectomy. Primary endpoints were five-year survival, progression free survival, and overall survival. Available multivariable hazard ratios and corresponding 95% CIs were included in the qualitative analysis. The risk of bias was completed for nonrandomized studies. (3) Results: Using PRISMA guidelines, our electronic search resulted in a total of 1862 records. After a detailed review, we selected four studies that addressed the impact of the timing of adjuvant chemotherapy for patients who underwent radical cystectomy. (4) Conclusion: A survival benefit was seen with an earlier administration of adjuvant chemotherapy, albeit a benefit persists for delayed chemotherapy post-radical cystectomy. A safe and ethical approach at this time would be to administer adjuvant chemotherapy as early in the postoperative period as possible, given the known survival benefit of such therapy (9–11% absolute survival benefit at five years).

Wound dehiscence in enhanced recovery after open radical cystectomy: A meta‐analysis

“…Pre‐, intra‐, and post‐operative components are included in multimodal, interdisciplinary enhanced recovery after surgery pathways to lessen provider variance. ER, after‐surgery utilisation, may lead to a shorter length of stay, fewer problems, lower expenditures, and better wound healing 5‐13 . However, fewer reports compare ER after surgery's effect on wound dehiscence 14‐18 .…”

“…ER, after‐surgery utilisation, may lead to a shorter length of stay, fewer problems, lower expenditures, and better wound healing. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 However, fewer reports compare ER after surgery's effect on wound dehiscence. 14 , 15 , 16 , 17 , 18 We sought to comprehensively analyse in this meta‐analysis the outcome of ER after RC on wound dehiscence.…”