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Page 4 of 11 Cicione et al. Mini-invasive Surg 2021;5:47 https://dx.doi.org/10.20517/2574-1225.2021.52

Table 1. Studies reporting survival outcomes after SRC following trimodal treatment for MIBC
Follow SRC patients
Ref. Median age Oncological outcomes
up (n)
[5]
Eswara et al. 69.4 12 years 102 Disease-free survival rates in the immediate and delayed groups was
(27.5-88.9) 38% and 61%, respectively, at 10 years (P < 0.05) with an overall 10-
year disease-free survival rate of 48% for the entire cohort
George et al. [6] - 48.5 11 7 patients died of disease, 2 died of other cause at 27 and 53 months, 1
months was alive with distant metastases, and 1 was alive with no evidence of
disease
Cooke et al. [11] 65 (41-75) 11 years 38 The median time to cystectomy after the primary treatment was 12
months (range 56 days to 10 years). The median survival after
cystectomy was 15 months (95%CI: 9-23 months)
[12]
Nieuwenhuijzen et al. - - 27 The 3- and 5-year survival probability after cystectomy was 46%
(95%CI: 26-65) and 33% (11-54)
[13]
Bochner et al. - - 13 After a median follow up of 28 months, 15 patients (82%) were without
evidence of disease
[14]
Crawford et al. - - 34 About 50% of patients died for disease progression with a mean survival
time of 14.5 months
[15]
Freiha et al. - - 40 45% patients alive after 5 years
[16]
Swanson et al. 63 (41-79) - 62 14.5 months was the median time from the initial diagnosis of bladder
cancer to cystectomy
5-year survival rate after cystectomy for the whole group was 43.2%
Abratt et al. [17] 62 (36-82) - 46 SRC was need after a mean of 11 months after radiotherapy. The overall
5-year survival rate was 43% while it was worse (7%) in case of higher
grade and stage
[18]
Nurmi et al. 61 (32-74) - 20 Intractable voiding symptoms were also reason for SRC. The overall 5-
year survival rate after the operation was 61%
[7]
Linell et al. 66 (52-75) - 19 SRC performed both for tumour recurrence and/or bladder symptoms
The 5-year survival rate was 5 %
[8]
Konnak et al. 65 (50-82) - 18 Interval between RT and SRC ranged between 6 months-12 years, mean
2.5 years
The overall crude 5-year survival from the time of cystectomy was 50%
[9]
Smith et al. - - 80 The over-all 5-year survival rate was 37% while the postoperative
hospital mortality rate was 5%
[10]
Kulkarni et al. 71 (37-95) 4.51 6 No significative difference in terms of 5-years DFS between radical
years cystectomy and TMT (respectively, 73.2% vs. 76.6%) was computed.
SRC was performed in 6 (10.7%) of 56 patients who received TMT
SRC: Salvage radical cystectomy; MIBC: muscle invasive bladder cancer; DFS: disease free survival; TMT: trimodal treatment.
terms of survival was found for patients receiving SRC or not .
[11]

Eswara et al. retrospectively analyzed clinical data of 348 patients undergoing TMT with extensive TURB,
[5]
cisplatin-based chemotherapy, and almost 40 Gy radiotherapy. Patient’s features were similar to a previous
[11]
study by Cooke et al. except for the presence of hydronephrosis that was considered an exclusion
criterion for trimodal treatment. On overage, SRC was carried out no more than 10.3 months after the last
dose of chemotherapy. The 10-year disease free survival rate (DFS) from SRC was 48%, which significatively
improved (up to 61%) when the surgery was delayed compared to conservative treatment.

Interestingly, Schuettfort et al. recently used a pooled analysis method to assess the efficacy of trimodal
[22]
treatment. They reviewed the available literature and identified 73 studies including 9110 patients. The
analysis showed that SRC was necessary in 19.2% of cases and 5- and 10-year DFS rates were, respectively,
54.3% (95%CI: 48.6-60.1) and 45.6% (95%CI: 41.6-49.6).