THE ROLE OF SURGERY FOR LOCO-REGIONAL AND ADVANCED UROLOGICAL CANCERS: Edited by Declan Murphy and Derya TilkiThe role of surgery for locally advanced urothelial cancersIbilibor, Christine; Kennady, Emmett H.; Greene, Kirsten L. Author Information University of Virginia, Department of Urology, Charlottesville, Virginia, USA Correspondence to Kirsten L. Greene, MD, FACS, Department of Urology, PO Box 800422, Charlottesville, VA 22908-0422, USA. Tel: +1 434 924 2224; e-mail: [email protected] Current Opinion in Urology 32(6):p 614-617, November 2022. | DOI: 10.1097/MOU.0000000000001034 Buy Metrics Abstract Purpose of review Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy. Recent findings Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy. Summary Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.