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Cicione et al. Mini-invasive Surg 2021;5:47 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.52

Review Open Access

An investigative review on the current role and

outcomes of salvage radical cystectomy

Antonio Cicione, Riccardo Lombardo, Olivia Alessandra Voglino, Andrea Tubaro, Cosimo De Nunzio
Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy.

Correspondence to: Dr. Antonio Cicione, Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Via di
Grottarossa 1085, Rome 00189, Italy. E-mail: acicione@libero.it

How to cite this article: Cicione A, Lombardo R, Voglino OA, Tubaro A, De Nunzio C. An investigative review on the current role
and outcomes of salvage radical cystectomy. Mini-invasive Surg 2021;5:47. https://dx.doi.org/10.20517/2574-1225.2021.52

Received: 20 Apr 2021 First Decision: 10 May 2021 Revised: 12 May 2021 Accepted: 17 May 2021 Published: 8 Oct 2021

Academic Editor: Riccardo Autorino Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Salvage radical cystectomy (SRC) is currently performed after failure of a trimodal treatment (TMT) for muscle
invasive bladder cancer (MIBC) and also as a palliative surgery to manage bladder cancer-related symptoms. We
reviewed the available literature to assess the current outcomes of SRC. A comprehensive research of the Medline
and Embase databases was carried out by following the Preferred Items for Systematic Reviews and Meta-
Analysis. Bladder cancer, radiotherapy, salvage, and cystectomy were the main keywords used in the research. Due
to the lack of studies, no time restriction was applied, however only English language and only studies using
Clavien-Dindo Grade (CCS) to report complications were considered. Overall, 285 studies were identified, of which
41 studies were considered eligible for the purpose of this review. No comparative studies were found between
TMT plus SRC and immediate radical cystectomy. Thirteen studies reported oncological outcomes after TMT. The
five-year mean disease free survival rate of patients who underwent SRC after TMT was reported to be about 50%
and the 5-year OS rate was between 33% and 48%. Three studies including fewer than 20 patients performed SRC
with palliative purpose. Although no perioperative death occurred, patients were highly selected. Overall, 4 studies
graded surgery-related complications by CCS. The rate of major complications, defined as CCS ≥ 3, was reported to
be between 16% and 32%, most of them being gastrointestinal complications. SRC still preserves a role in the
management of MIBC, being part of TMT and palliative care in highly selected patients. However, this surgery is at
higher risk of complications and is associated with incontinent urinary diversion, thus an accurate discussion during
patient counseling is advisable.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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