Nodal Disease and Surgical Decision-Making in MIBC

In “Nodal Disease and Surgical Decision-Making in MIBC,” our panel explores how newer perioperative systemic therapies are changing the management of patients with node-positive and advanced muscle-invasive bladder cancer (MIBC). The expert urologic oncology faculty discuss how the emergence of highly active regimens such as enfortumab vedotin plus pembrolizumab (EVP) has shifted expectations regarding surgical candidacy and outcomes in patients who historically may not have proceeded to radical cystectomy following systemic therapy.

Throughout the discussion, the panelists compare current experiences with historical approaches using cisplatin-based chemotherapy, noting that relatively few patients with nodal metastatic disease previously achieved responses sufficient to proceed to surgery. The faculty highlight how newer therapies are increasing the number of patients achieving meaningful radiographic responses and prompting renewed discussions regarding consolidative surgery following systemic treatment.

The panel also examines evolving perspectives surrounding lymph node dissection and retroperitoneal disease management in patients responding to perioperative therapy. In addition, the discussion explores how improved systemic therapies are influencing multidisciplinary tumor board discussions and reshaping treatment algorithms for patients with pelvic and retroperitoneal nodal involvement.

Finally, the faculty discuss ongoing uncertainty regarding the optimal extent of surgery in patients with excellent responses to systemic therapy, including whether all residual nodal sites require resection following perioperative treatment. The panel emphasizes that although these therapies are expanding surgical opportunities in advanced MIBC, additional clinical data are needed to better define the role of surgery and lymph node dissection in this evolving treatment landscape.

Our next episode, “Lymph Node Dissection Following Systemic Therapy in MIBC,” features the panelists discussing how perioperative systemic therapies are influencing lymph node dissection, robotic surgery, and consolidative surgical strategies in muscle-invasive bladder cancer. The panel also highlights emerging data evaluating surgical outcomes following newer immunotherapy- and antibody-drug conjugate-based regimens in advanced MIBC.