Editing Muscle-Invasive Bladder Cancer (section)

=== Maximal TURBT/partial cystectomy ===
* '''See [[Cystectomy]] Chapter Notes'''
*'''See [[CUA: Muscle-invasive Bladder Cancer (2019)|2019 CUA MIBC Guideline Notes]]'''
*'''Patients with MIBC who are medically fit and consent to radically cystectomy should not undergo maximal TURBT or partial cystectomy as primary curative therapy'''
**Therapies other than radical cystectomy (e.g., partial cystectomy, TURBT alone, chemotherapy alone, or radiation alone) and multi-modal bladder preserving therapy are associated with increased risk of all-cause mortality
*'''Patients who are unfit for cystectomy and multi-modal bladder preserving therapy may be offered'''
**'''Radical, maximal TURBT alone''' if they have a tumor that can be macroscopically resected completely, and for which repeat TURBT is negative '''OR'''
**'''Partial cystectomy, bilateral pelvic lymphadenectomy and perioperative chemotherapy for cisplatin-eligible patients'''
***'''If they meet the following criteria:'''
***#'''Accessible tumor location'''
***#'''Size <3cm'''
***#'''No multi-focal CIS'''
***#'''No hydronephrosis'''
***#'''Adequate bladder function'''
***#'''No residual T1 or higher stage disease'''
*Patients should be informed that approximately 40% of patients treated in this manner will ultimately require cystectomy and may have an increased risk of bladder cancer mortality.
*For patients with MIBC that have chosen maximal TURBT, no further treatment may be required if they have a tumor that can be macroscopically resected completely, and for which repeat TURBT is negative.**Studies have demonstrated that a significant proportion of patients with small MIBC’s who have a negative re-resection may be locally controlled by TURBT.
*For cisplatin-eligible patients with MIBC patients that have chosen partial cystectomy and pelvic lymphadenectomy, perioperative chemotherapy should be offered.