Does Timing Matter? Perioperative Outcomes and Quality of Life After Early Versus Delayed Radical Cystectomy Following BCG Therapy.

Objectives: To determine whether the timing of radical cystectomy (RC), either early versus delayed following BCG therapy, affects perioperative outcomes and health-related quality of life (HRQOL) in patients with very-high-risk non-muscle invasive bladder cancer (NMIBC). While existing data focus on oncological endpoints, the impact of BCG on these outcomes remains unevaluated. Methods: We retrospectively analysed a prospectively maintained database of 126 patients undergoing RC for very-high-risk NMIBC at a tertiary referral centre, stratified into early RC (n = 81) and delayed RC (n = 45, following BCG therapy). Perioperative outcomes, HRQOL assessed by EORTC-QLQ-C30 at baseline and 3, 12, and 24 months postoperative, and overall survival (OS) were compared. Longitudinal HRQOL changes were analysed using linear mixed-effects models adjusted for age and Carcinoma in situ (CIS) status, correcting for multiple comparisons. Results: Groups were well-balanced at baseline regarding age, sex, BMI, and ECOG performance status. No significant between-group differences were observed in overall complication rates, hospital stay length, or any QLQ-C30 domain at any timepoint, including global health status (GHS), in linear mixed-effects models accounting for repeated measures and multiple comparisons. OS did not differ between groups (p = 0.720). Conclusions: Prior BCG therapy does not adversely influence perioperative outcomes or HRQOL following RC for very-high-risk NMIBC. These findings support the initial use of BCG in eligible patients, as a trial of intravesical therapy does not appear to compromise surgical safety or postoperative quality of life when cystectomy is ultimately required.