Management of metastatic urothelial cancer: the role of surgery as an adjunct to chemotherapy

Metastatic or unresectable disease is identified in approximately 20% of patients presenting with invasive urothelial cancer. In addition, up to 50% of patients will develop metastases following radical cystectomy for clinically localized disease. Multiagent cisplatin-based chemotherapy is considered standard first-line treatment for these patients. Although urothelial cancer is considered a chemosensitive tumour, metastatic disease is associated with poor prognosis and short-term survival. Here, we review the role of a multidisciplinary approach to treating patients with metastatic urothelial cancer.