Oncological Surveillance After Radical Cystectomy: a Narrative Review of the Enhanced Recovery After Surgery Cystectomy Committee

Abstract

Purpose: Follow-up after cystectomy aims to detect relapse, but there are discrepancies in recommendations among guidelines. Routine follow-up for asymptomatic recurrences in urothelial cancer is primarily based on nonvalidated risk factors from retrospective cohort studies in single institutions. This review provides an overview of follow-up investigations, schedules, and potential risk factors of recurrence. Materials and methods: We conducted a narrative literature search on PubMed and reviewed guidelines (European Society for Medical Oncology, European Association of Urology, National Comprehensive Cancer Network, American Urology Association, and National Institute for Health and Care Excellence) and institutional protocols for cystectomy patients. Results: Our analysis included 29 studies with 23,218 patients. Most relapses occurred within 2 years, either locally or as distant recurrences in the chest, liver, bones, or brain. Factors increasing relapse risk included higher tumor stage, nodal involvement, histological subtypes, and lymphovascular invasion. Surveillance protocols varied in frequency and type of investigation. Limited recommendations were available for patients with ypT0, pT0, or non–muscle-invasive bladder cancer. Conclusions: Further research is needed to evaluate the impact of postcystectomy follow-up protocols on oncological outcomes and establish optimal surveillance procedures.