OBJECTIVES:To compare the oncologic outcomes and safety profiles of Bacillus Calmette-Guérin (BCG) versus gemcitabine/docetaxel (Gem/Doce) maintenance following BCG induction in treatment-naïve non-muscle-invasive bladder cancer (NMIBC). METHODS:We identified patients with treatment-naive NMIBC who received induction BCG followed by maintenance BCG per the Southwest Oncology Group Cancer Research Network protocol or Gem/Doce monthly for 1 year (2016-2026). Oncological outcomes included recurrence-free survival (RFS), high-grade RFS, progression-free survival, and metastasis-free survival. Adverse events were systematically assessed to evaluate treatment tolerability. RESULTS:Overall, 128 patients received BCG induction followed by either BCG maintenance (n = 98; 76.6%) or Gem/Doce maintenance (n = 30; 23.4%). After a median follow-up of 75.0 months (interquartile range [IQR] 66.7-86.5) in the BCG group and 22.5 months (IQR 14.8-42.9) in the Gem/Doce group (P < 0.001), 3-year RFS (80.0% vs. 83.8%; P = 0.8), 3-year high-grade RFS (83.4% vs. 92.2%; P = 0.7), 3-year progression-free survival (90.0% vs. 96.6%; P = 0.4), and 3-year metastasis-free survival (96.8% vs. 100.0%; P = 0.3) were comparable between the BCG and Gem/Doce maintenance groups, respectively. Multivariable Cox regression analysis confirmed that Gem/Doce versus BCG maintenance was not associated with disease recurrence (hazard ratio 1.04; 95% confidence interval 0.39-2.83; P > 0.9). Overall, Gem/Doce maintenance was better tolerated, with fewer patients reporting adverse events (6.7% vs. 28%, P = 0.02) and no severe events observed during the maintenance phase. Limitations of the study include its retrospective design and the relatively small sample size of the Gem/Doce cohort. CONCLUSION:Sequential Gem/Doce maintenance following BCG induction achieved oncologic outcomes comparable to those with BCG maintenance, with improved tolerability, highlighting its feasibility as an alternative in cases of BCG intolerance or shortage.

Myocardial infarction and ischemic stroke are common causes of morbidity after major cancer surgery. Understanding the risks associated with both open and laparoscopic surgery is crucial in reducing postoperative morbidity and mortality. This nationwide cohort study included patients who underwent major cancer surgery in the pelvis from 2000 to 2015. The primary outcome was the incidence of myocardial infarction and ischemic stroke within 90 days postoperatively. Adjusted odds ratios (OR) were estimated using logistic regression adjusted for propensity score and risks by regression standardization. A total of 22,619 patients operated with laparoscopic and 70,896 patients operated with open approach were included in the analysis. The crude 90-day cumulative risks of myocardial infarction and ischemic stroke were 0.66

PURPOSE:To develop contemporary evidence-informed recommendations for robot-assisted radical cystectomy (RARC), urinary reconstruction, and perioperative management, integrating current evidence with the experience of Latin American experts in uro-oncology and robotic surgery. MATERIALS AND METHODS:A modified Delphi consensus process was conducted involving 42 experts with extensive experience in RARC. Topics included patient selection, perioperative optimization, enhanced recovery after surgery (ERAS), lymph node dissection, urinary reconstruction, functional preservation, perioperative systemic therapy, complex clinical scenarios, and emerging robotic technologies. A comprehensive literature review was performed using Medline, Scopus, and Web of Science through November 2025, following PRISMA principles and incorporating recommendations from EAU, AUA/ASCO/SUO, and NCCN guidelines. Consensus was defined as ≥75% agreement. RESULTS:Consensus supported routine implementation of ERAS protocols, structured frailty and nutritional assessment, extended pelvic lymph node dissection, and perioperative systemic therapy in eligible patients. Intracorporeal urinary diversion was associated with improved recovery and lower wound-related morbidity. Nerve-sparing and organ-preserving approaches were recommended in selected patients to optimize continence, sexual function, and quality of life. Orthotopic neobladder reconstruction should be individualized according to oncologic safety, functional status, renal function, and patient preference. RARC was considered feasible in complex settings, including obesity, bulky lymphadenopathy, locally advanced disease, and salvage surgery, when performed in experienced high-volume centers. Areas without consensus included urinary drainage strategies and antibiotic prophylaxis duration. CONCLUSIONS:This expert consensus provides recommendations for RARC and urinary reconstruction, aiming to standardize practice, optimize perioperative care, and improve oncological and functional outcomes. Future prospective studies are needed.

BACKGROUND AND OBJECTIVE:Pure urothelial carcinoma (UC) and histological subtypes (HS) in bladder cancer (BC) are associated with distinct pathological features and oncologic outcomes across disease stages. Circulating tumor DNA (ctDNA) is a promising perioperative biomarker, but its prognostic performance across histologic subtypes remains unclear. We evaluated the prognostic value of perioperative tumor-informed ctDNA in patients with pure UC and HS. METHODS:We analyzed a database of consecutive patients with BC who underwent radical cystectomy with available preoperative or postoperative ctDNA between 2021 and 2025. Patients were stratified into four groups according to histology status and ctDNA detectability at both preoperative and postoperative time points. Disease-free survival (DFS) was estimated using the Kaplan-Meier method and compared with log-rank tests. Associations between groups and DFS were evaluated using uni- and multivariable Cox regression analyses. KEY FINDINGS AND LIMITATIONS:Among 138 patients with preoperative ctDNA, negative ctDNA status was associated with significantly higher 24-mo DFS compared with positive ctDNA in both pure UC (89% vs 49%, p < 0.001) and HS (79% vs 43%, p = 0.012). Multivariable Cox regression confirmed positive preoperative ctDNA as an independent predictor of recurrence or death in pure UC (hazard ratio [HR] = 4.07, 95% confidence interval [CI] = 1.29-12.81, p = 0.020) and HS groups (HR = 3.99, 95% CI = 1.24-12.82, p = 0.023). Similarly, among 144 patients with postoperative ctDNA, negative ctDNA status predicted higher 24-mo DFS in pure UC (81% vs 30%, p < 0.001) and HS (66% vs 29%, p < 0.001), with positive postoperative ctDNA independently associated with disease recurrence or death in pure UC (HR = 4.38, 95% CI = 1.66-11.52, p < 0.01) and HS groups (HR = 4.52, 95% CI = 1.86-11.03, p < 0.001). Limitations include the retrospective design and relatively short follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS:Perioperative ctDNA is a robust biomarker with consistent prognostic value and can refine perioperative risk stratification in patients with BC with pure UC or HS.