ESU-ESOU Virtual Masterclass on MIBC

from European Urology Today Vol. 33 No.2 - March/May 2021

by European Association of Urology (EAU)

Key articles from international medical journals

Essential treatment updates, diagnosis and histology

Amassing an attendance of 50 participants from 22 countries across the world, the ESU-ESOU Virtual Masterclass on Muscle-invasive bladder cancer took place on 8 and 9 April 2021. The masterclass faculty was comprised of esteemed experts led by Course Director Prof. Fred Witjes (NL), ESU Chair Prof. Joan Palou (ES), and ESOU Chairman Prof. Morgan Rouprêt (FR). This masterclass was organised through the collaborative efforts of the European School of Urology (ESU) and the EAU Section of Oncological Urology (ESOU).

Day one commences The first session “Diagnosis and Initial Treatment” kickstarted with a comprehensive presentation by Prof. Valeria Panebianco (IT) on diagnostic tools for muscle invasive bladder cancer (MIBC) with an emphasis on nodes comparing CT, MRI, PET-CT scans. This was followed by the lecture of Dr. Erik Veskimäe (FI) which was entitled “Histological variant bladder cancers and clinical consequences for treatment (invasive and metastatic disease)”.

According to Dr. Veskimäe, the 2016 World Health Organization (WHO) classification of the urinary system enables pathologists, urologists and oncologists to improve understanding about variant histology of bladder cancer (BCa). Furthermore, preliminary data suggests that patients with MIBC could benefit from tailored treatment based on histological variant. He added that patients with metastatic variant histology BCa should receive chemotherapy and the role of immunotherapy remains to be seen. The session concluded with a semi-live video demonstrating radical transurethral resection (TUR) for small invasive BCa.

The “Cystectomy and Node Dissection” session commenced with the presentation of Prof. Bas Van Rhijn (NL) “ERAS in Cystectomy: What has to be done and what is the impact”. He explained that Enhanced Recovery After Surgery (ERAS) is a concept of a multidisciplinary, fast-track pathway including pre-operative, per-operative and post-operative measures that was first introduced in the ‘90s by Scandinavian surgeons in colorectal surgery.

“The same ERAS-concept has subsequently also been applied to cystectomy. The ERAS society has formulated recommendations in 2013 showing the impact of specific interventions for cystectomy. However, the level of evidence in favour of ERAS is still low and the ERAS protocols and items used in studies are very different between these studies. This indicates the need for multiple (randomised) studies to specifically determine which ERAS items are associated with the highest benefit for our patients,” stated Prof. Van Rhijn.

His presentation was followed by a lecture by Prof. Maria Ribal on the extent and survival of a node dissection with videos demonstrating open and lap/robot technique of node dissection, as well as, videos on robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC).

The first day ended with lively discussions and participant presentations during the Journal Club segment where four papers were presented by the participants and discussed by all.

Coverage of day two Prof. Witjes welcomed participants on Friday morning with a recap of day one. A presentation on bladdersparing options by Prof. Nicholas James (GB) followed, then deliberations during “Point - Counterpoint: T2/3N0M0, 4 cm, MMT or RC” between Prof. Van Rhijn for multimodality treatments (MMT) and Prof. Marek Babjuk (CZ) for RC. A semi-live surgical video presentation by Prof. Witjes on prostate-sparing RC took place after. Further into the masterclass, the session on diversion kickstarted with videos on the “W” and “S” type neobladders by Prof. Babjuk and Prof. George Thalmann (CH), respectively. This was followed by the video presentation “Uni or bilateral uretero cutaneostomy” by Dr. Antoine Van Der Heijden (NL). Afterwards, Prof. Thalmann shared his insights in his lecture “Neobladdder: What is the best diversion?”.

“The question is ultimately not what is the best diversion, but rather, what is the best diversion for the patient. This depends on many factors and should be determined in a shared decision-making process taking into account the patient’s situation, needs, and hopes to provide the best quality of life possible in their individual situation,” said Prof. Thalmann.

In the lecture “Complications after RC and management, what to expect and how to prevent and solve”, Prof. Joan Palou (ES) stated that about 60% of the patients present one complication and that 10 to 20% have complications that are classified grade III in the Clavien-Dindo System. Prof. Palou added that patients should be aware that complications in radical cystectomy do happen. He said, “The most important about complications is to detect them as soon as possible and to treat them immediately.”

The final session of the masterclass, “Recurrent or Metastatic Disease” commenced with the lecture of Dr. Richard Cathomas (CH) on systemic therapy updates covering chemotherapy and immune therapy. Afterwards, the faculty discussed patient cases which include clinical cases prepared by participants, then the masterclass came to a close.

You can access or review the masterclass presentations via www.urosource.org. Feel free to check out the conversations on Twitter by using the hashtag #esumibc21. Interested in participating in upcoming ESU masterclasses? Visit www.esumasterclasses.org for the overview and apply now!

Prof. Ribal discusses mapping studies of lymph node metastasis