Dr Lotan on the Benefits and Complications Associated With Radical Cystectomy in BCG-Unresponsive NMIBC

“If a patient has the bladder removed when their cancer is noninvasive, their outcomes are superior to waiting until the cancer becomes invasive. Therefore, there is an opportunity to cure that patient. However, the consequences of bladder removal are lifelong and can have implications on urinary function—because [patients] have to have a urinary diversion;sexual function; and potentially bowel function.”

Yair Lotan, MD, professor, urology, chief, urologic oncology, Jane and John Justin Distinguished Chair in Urology, UT Southwestern Harold C. Simmons Comprehensive Cancer Center; medical director, Urology Clinic, UT Southwestern and Parkland Health and Hospital System, discusses the benefits and complications associated with radical cystectomy for patients with Bacillus Calmette–Guérin (BCG)–unresponsive non–muscle-invasive bladder cancer (NMIBC).

The National Comprehensive Cancer Network and American Urological Association guidelines outline multiple FDA-approved treatment options for patients with BCG-unresponsive NMIBC, along with commonly used non–FDA-approved therapies, Lotan begins. Among these, radical cystectomy remains the definitive treatment option and offers the highest likelihood of cure, particularly when performed at a time when the disease is still noninvasive, he states. Delaying bladder removal until cancer progresses to an invasive state reduces the chance of achieving long-term disease control and cure, underscoring the importance of early intervention, Lotan states.

Despite its curative potential, bladder resection has significant long-term consequences, he notes. Patients undergoing resection require a urinary diversion, which can affect urinary, sexual, and bowel function, he explains, adding that these functional changes are lifelong and can affect quality of life. Radical cystectomy is also associated with a relatively high rate of short-term complications, Lotan adds. It is a major surgical procedure that involves a recovery period spanning weeks to months, he reiterates. Most patients require a hospital stay of approximately 5 to 6 days, regardless of whether the surgery is performed via an open approach or robotically, Lotan concludes.