Surgical Timing in the Perioperative Era of MIBC

This episode, titled “Surgical Timing in the Perioperative Era of MIBC,” features panelists discussing how emerging perioperative therapies are influencing surgical management and postoperative care in muscle-invasive bladder cancer (MIBC). The expert faculty explore how immunotherapy- and antibody-drug conjugate-based regimens, including enfortumab vedotin plus pembrolizumab (EVP) and perioperative durvalumab plus gemcitabine-cisplatin, are affecting operative planning, treatment timing, and recovery surrounding radical cystectomy.

Throughout the discussion, the panel highlights how newer perioperative approaches have introduced unique immune-related toxicities and perioperative considerations while also reducing some of the hematologic and nutritional challenges historically associated with cisplatin-based chemotherapy. The faculty discuss how patients receiving newer systemic therapies may arrive at surgery with improved blood counts, less frailty, and fewer chemotherapy-related complications compared with traditional neoadjuvant chemotherapy approaches.

The panelists also review practical surgical considerations, including the timing of surgery following systemic therapy, management of patients requiring high-dose corticosteroids for immune-related adverse events, and postoperative concerns such as nephritis, wound healing, and urinary diversion outcomes. In addition, the discussion explores how evolving systemic therapies may influence future decisions regarding treatment sequencing and the duration of neoadjuvant therapy prior to radical cystectomy. Finally, the faculty emphasize that although perioperative therapies may alter certain perioperative considerations, the fundamental surgical principles of radical cystectomy and urinary diversion remain largely unchanged in the modern management of MIBC.

In the next episode, “Surgical Perspectives on Perioperative Therapy in MIBC,” panelists will discuss how perioperative systemic therapies are influencing operative planning, lymph node management, and postoperative treatment decisions in muscle-invasive bladder cancer. The panel will also highlight real-world surgical experiences following newer immunotherapy- and antibody-drug conjugate-based regimens.