The first paper she highlighted was the SWOG S0337 trial of gemcitabine versus saline in the prevention of bladder cancer recurrence in non-muscle invasive bladder cancer (NMIBC) which was published by Dr. Messing in JAMA. This trial demonstrated a significant decrease both in the intention to treat a population of patients suspected of having low-risk NIMIBC and an even greater benefit among the per-protocol analysis of patients with pathologically proven low risk disease.
Dr. Smith stated that this manuscript affected her choice of intravesical agent following TURBT with subsequent infrequent use of mitomycin C. Additionally, she used postoperative intravesical therapy with gemcitabine to reduce bladder cancer recurrence following nephroureterectomy.
Her second influential paper was a randomized trial of extended versus limited lymph node dissection in patients undergoing radical cystectomy by Gschwend et al. in European Urology.
This study showed that extended lymph node dissection did not significantly increase complications. However, benefit was not observed. Therefore, Dr. Smith stated that she is more selective in the use of extended node dissection, omitting it in older, more comorbid patients. However, limitations in the study design, as highlighted by Seth Lerner in an accompanying editorial led her to await more definitive results from SWOG S1011 before definitive changes in clinical practice.
Finally, she highlighted a retrospective analysis from the University of Pittsburgh assessing the use of palliative care in patients undergoing cystectomy.
Interestingly, rate of palliative care consultation were similarly low for patients with both localized disease (3.3%) and advanced disease (4.1%). Rates of palliative consultation were stable over time.
As a result of this paper, Dr. Smith said that she is more cognizant of incorporating palliative care consultation and identifying patients at greatest need.
Presented by: Angela Smith, MD, MS, FACS, University of North Carolina
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, @WallisCJD on Twitter, at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois