Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer

https://www.europeanurology.com/article/S0302-2838(13)01310-9/pdf/eau-guidelines-on-muscle-invasive-and-metastatic-bladder-cancer-summary-of-the-2013-guidelines

EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2013 Guidelines

https://www.europeanurology.com/article/S0302-2838(14)01294-9/pdf/comparison-of-perioperative-outcomes-between-robotic-and-laparoscopic-partial-nephrectomy-a-systematic-review-and-meta-analysis

Comparison of Perioperative Outcomes Between Robotic and Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis

https://www.europeanurology.com/article/S0302-2838(14)00491-6/pdf/the-impact-of-the-extent-of-lymphadenectomy-on-oncologic-outcomes-in-patients-undergoing-radical-cystectomy-for-bladder-cancer-a-systematic-review

The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Systematic Review

The landscape of local and systemic therapy of renal cell carcinoma (RCC) is rapidly changing. The increase in the incidental finding of small renal tumors has increased the application of nephron-sparing procedures, while ten novel agents targeting the vascular endothelial growth factor (VEGF) or the mammalian target of rapamycin pathways, or inhibiting the interaction of the programmed death 1 receptor with its ligand, have been approved since 2006 and have dramatically improved the prognosis of metastatic RCC (mRCC). These rapid developments have resulted in continuous changes in the respective Clinical Practice Guidelines/Expert Recommendations. We conducted a systematic review of the existing guidelines in MEDLINE according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, aiming to identify areas of agreement and discrepancy among them and to evaluate the underlying reasons for such discrepancies. Data synthesis identified selection criteria for nonsurgical approaches in renal masses; the role of modern laparoscopic techniques in the context of partial nephrectomy; selection criteria for cytoreductive nephrectomy and metastasectomy in mRCC; systemic therapy of metastatic non-clear-cell renal cancers; and optimal sequence of available agents in mRCC relapsed after anti-VEGF therapy as the major areas of uncertainty. Agreement or uncertainty was not always correlated with the availability of data from phase III randomized controlled trials. Our review suggests that the combination of systematic review and critical evaluation can define practices of wide applicability and areas for future research by identifying areas of agreement and uncertainty among existing guidelines. Implications for practice Currently, there is uncertainity on the role of surgery in MRCC and on the choice of available guidelines in relapsed RCC. The best practice is individualization of targeted therapies. Systematic review of guidelines can help to identify unmet medical needs and areas of future research.

Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation

Objective

To compare extended pelvic lymph node dissection (ePLND) with non-extended pelvic lymph node dissection (non-ePLND) and assess their influence on recurrence-free survival (RFS) in patients undergoing radical cystectomy for bladder cancer.




Methods

Through a comprehensive search of the PubMed, Embase and Cochrane Library databases in September 2012, we performed a systematic review and cumulative meta-analysis of all comparative studies assessing the extent of pelvic lymph node dissection (PLND) and its influence on RFS.




Results

Six studies with a total of 2824 patients were identified.
Overall analysis showed a significantly better RFS rate in patients who had undergone ePLND than in those who had undergone non-ePLND (hazard ratio [HR]: 0.65; P < 0.001).
A subgroup analysis found that, compared with non-ePLND, ePLND was associated with a better RFS rate for both patients with negative lymph nodes (HR: 0.68; P = 0.007) and those with positive lymph nodes (HR: 0.58; P < 0.001). When stratified by pathological T stage, ePLND provided additional RFS benefits for patients with pT3–4 disease (HR: 0.61; P < 0.001), but not for patients with ≤pT2 disease (HR: 0.95; P = 0.81).




Conclusions

The results of this meta-analysis indicate that ePLND provides a RFS benefit compared with non-ePLND. On subgroup analysis, ePLND provides better RFS not only for patients who had positive lymph nodes and pT3–4 disease, but also for patients with negative lymph nodes.
Two randomized controlled trials on ePLND vs non-ePLND are awaited which should provide more clinically meaningful results.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bju.12371

Extended vs non-extended pelvic lymph node dissection and their influence on recurrence-free survival in patients undergoing radical cystectomy for bladder cancer: a systematic review and meta-analysis of comparative studies.

Background
With the establishment of minimally invasive surgery in society, the robot has been increasingly widely used in the urologic field, including in partial nephrectomy. This study aimed to comprehensively summarize the currently available evidence on the feasibility and safety of robotic partial nephrectomy for renal tumors of >4 cm.

/pdf/robotic-partial-nephrectomy-for-renal-tumors-larger-than-4-p1f4hf527k.pdf

Robotic Partial Nephrectomy for Renal Tumors Larger than 4 cm: A Systematic Review and Meta-analysis

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Extended vs non-extended pelvic lymph node dissection and their influence on recurrence-free survival in patients undergoing radical cystectomy for bladder cancer: a systematic review and meta-analysis of comparative studies.

Robotic Partial Nephrectomy for Renal Tumors Larger than 4 cm: A Systematic Review and Meta-analysis