Radical cystectomy with lymph node dissection (LND) is recommended for muscle-invasive bladder cancer (BCa).
Retrospective studies have shown that 5-yr disease-specific survival does not exceed 66% because of the high number of patients with lymph node involvement and micrometastases at diagnosis  .
In patients with pT2 and pT3–4 tumours, local recurrence was observed in 3–4% and 11–16%, whereas distant metastases occurred in 10–27% and 19–35%, respectively  . In the early 1980s, median survival in untreateted was only 6 mo  . To improve these unsatisfactory results, systemic perioperative chemotherapy with the potential to eradicate micrometastases and improve survival has been introduced as an adjunct to cystectomy in neoadjuvant (preoperative) and adjuvant (postoperative) settings.
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