Context

The role of surgery in metastatic bladder cancer (BCa) is unclear.

Objective

In this collaborative review article, we reviewed the contemporary literature on the surgical management of metastatic BCa and factors associated with outcomes to support the development of clinical guidelines as well as informed clinical decision-making.

Evidence acquisition

A systematic search of English language literature using PubMed-Medline and Scopus from 1999 to 2016 was performed.

Evidence synthesis

The beneficial role of consolidation surgery in metastatic BCa is still unproven. In patients with clinically evident lymph node metastasis, data suggest a survival advantage for patients undergoing postchemotherapy radical cystectomy with lymphadenectomy, especially in those with measurable response to chemotherapy (CHT). Intraoperatively identified enlarged pelvic lymph nodes should be removed. Anecdotal reports of resection of pulmonary metastasis as part of multimodal approach suggest possible improved survival in well-selected patients. Cytoreductive radical cystectomy as local treatment has also been explored in patients with metastatic disease, although its benefits remain to be assessed.

Conclusions

Consolidative extirpative surgery may be considered in patients with clinically evident pelvic or retroperitoneal lymph nodal metastases but only if they have had a response to CHT. Surgery for limited pulmonary metastases may also be considered in very selected cases. Best candidates are those with resectable disease who demonstrate measurable response to CHT with good performance status. In the absence of data from prospective randomized studies, each patient should be evaluated on an individual basis and decisions made together with the patient and multidisciplinary teams.

Patient summary

Surgical resection of metastases is technically feasible and can be safely performed. It may help improve cancer control and eventually survival in very selected patients with limited metastatic burden. In a patient who is motivated to receive chemotherapy and to undergo extirpative surgical intervention, surgery should be discussed with the patient among other consolidation therapies in the setting of multidisciplinary teams.

中文翻译：

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手术在转移性膀胱癌中的作用：系统评价

语境

手术在转移性膀胱癌（BCa）中的作用尚不清楚。

客观的

在这篇协作性综述文章中，我们回顾了有关转移性BCa的外科治疗以及与结局相关的因素的当代文献，以支持临床指南的制定以及明智的临床决策。

取证

从1999年到2016年，使用PubMed-Medline和Scopus对英语文献进行了系统的检索。

证据综合

巩固手术在转移性BCa中的有益作用仍未得到证实。在临床上明显有淋巴结转移的患者中，数据表明接受化疗后行根治性膀胱切除术并淋巴结清扫术的患者具有生存优势，尤其是对化疗（CHT）有可测量反应的患者。术中发现的盆腔淋巴结肿大应予以切除。切除肺转移的传闻报道是多模式方法的一部分，提示在精心挑选的患者中可能会改善生存率。转移性疾病患者也已探索了使用细胞还原性根治性膀胱切除术作为局部治疗的方法，尽管其益处尚待评估。

结论

有骨盆或腹膜后淋巴结转移的临床上明显的患者可以考虑进行巩固性根除术，但前提是他们对CHT有反应。在极少数情况下，也可考虑进行有限的肺转移手术。最佳候选人是那些具有可切除疾病且对CHT表现出可测量的反应且表现良好的人。在缺乏前瞻性随机研究数据的情况下，应根据个人情况评估每个患者，并与患者和多学科团队一起制定决策。

病人总结

转移瘤的手术切除在技术上是可行的，可以安全地进行。它可能有助于改善癌症控制，并最终改善转移负担有限的特选患者。对于有动机接受化学疗法并接受外科手术干预的患者，应在多学科团队的背景下与患者讨论外科手术以及其他巩固疗法。