Surgical Perspectives on Perioperative Therapy in MIBC

In this episode, “Surgical Perspectives on Perioperative Therapy in MIBC,” the panelists explore how perioperative systemic therapies are influencing surgical planning and operative experience in muscle-invasive bladder cancer (MIBC). The expert urologic oncology faculty review surgical video cases following perioperative treatment approaches and discuss how these newer therapies are affecting tissue planes, operative complexity, and postoperative treatment considerations surrounding radical cystectomy.

Throughout the discussion, the panel highlights how perioperative therapy has raised important questions regarding surgical timing, lymph node management, and postoperative systemic treatment strategies in patients with residual nodal disease. The faculty discuss how evolving treatment paradigms are changing the role of surgery in patients who achieve significant responses following systemic therapy, including those with initially node-positive disease.

The panelists also examine the impact of perioperative regimens on tissue characteristics encountered during surgery and share their experience that, in many patients, operative planes and surgical technique remain largely unchanged despite prior systemic therapy. In addition, the discussion explores the continued importance of pelvic lymph node dissection and how surgeons are adapting operative planning in the setting of increasingly effective systemic therapies. Finally, the faculty review ongoing unanswered questions regarding postoperative management after perioperative regimens, including how to approach patients with residual nodal disease following surgery and how emerging therapies may continue to refine the integration of surgery and systemic treatment in the modern management of MIBC.

The next episode in this series, “Nodal Disease and Surgical Decision-Making in MIBC,” features the panelists discussing how newer perioperative therapies are changing surgical decision-making for patients with node-positive muscle-invasive bladder cancer. The panel also highlights evolving perspectives on lymph node dissection, consolidative surgery, and multidisciplinary treatment planning in advanced MIBC.