Lymph Node Dissection Following Systemic Therapy in MIBC

This episode, titled “Lymph Node Dissection Following Systemic Therapy in MIBC,” features panelists discussing how perioperative systemic therapies are influencing surgical management for patients with node-positive and advanced muscle-invasive bladder cancer (MIBC). The expert urologic oncology faculty review operative video cases demonstrating the impact of immunotherapy- and antibody-drug conjugate-based treatment approaches on tissue characteristics, lymph node dissection, and surgical planning following systemic therapy.

Throughout the discussion, the panel highlights how perioperative regimens such as enfortumab vedotin plus pembrolizumab (EVP) may lead to varying degrees of fibrosis, inflammation, and desmoplastic reaction surrounding previously involved lymph nodes, while still allowing successful robotic radical cystectomy and extended lymph node dissection. The faculty discuss how these tissue changes may alter operative technique without fundamentally preventing safe or effective surgical resection.

The panelists also explore the emerging role of consolidative surgery following systemic therapy in patients with nodal or metastatic disease. In addition, the discussion reviews early retrospective experiences demonstrating encouraging pathologic complete response rates and progression-free survival outcomes following surgery in selected patients who responded to perioperative systemic therapy. The faculty emphasize the need for prospective clinical trials to better define the role of surgery after systemic therapy in advanced MIBC. The panel discusses ongoing institutional and multicenter studies evaluating consolidative surgery following newer perioperative regimens and highlights how these evolving strategies may continue to reshape surgical decision-making and multidisciplinary management in MIBC.

In the next episode, “Integrating ctDNA Into Perioperative Management of MIBC,” panelists will discuss how ctDNA and other emerging biomarkers are influencing perioperative treatment planning and postoperative management in muscle-invasive bladder cancer. The panel will also highlight the growing importance of multidisciplinary collaboration as systemic therapy and biomarker-driven approaches continue to evolve in MIBC.