Optimizing cystectomy outcomes in muscle-invasive bladder cancer: what's new in 2025?

INTRODUCTION

Radical cystectomy (RC) remains the gold standard surgical treatment for muscle-invasive bladder cancer (MIBC). It is a technically complex procedure with considerable short- and long-term morbidity, even in experienced hands.

AREAS COVERED: This review highlights recent advances in the multidisciplinary management of MIBC across the pre-, peri-, and post-operative phases. Improvements in surgical technique, peri-operative care pathways, and systemic therapies - including immunotherapy - have transformed outcomes. A targeted literature search was conducted using PubMed, Scopus, and Web of Science for English-language articles from 2015-2024, focusing on prospective studies from seminal clinical trials. Salient strategies were selected for inclusion based on clinical relevance and impact on patient outcomes.

EXPERT OPINION: Optimizing outcomes for patients undergoing RC requires an evidence-based, patient-centered approach. The addition of immunotherapy in the peri-operative setting has changed the standard of care. In the future, peri-operative treatment decisions may be guided by biomarkers such as circulating tumor DNA. Additionally, optimizing patient comorbidities, delivering individualized patient education, and adhering to enhanced recovery protocols remain essential to optimizing patient outcomes.