title: Open radical cystectomy: still the gold standard for muscle invasive bladder cancer.
abstract: BACKGROUND
  Muscle invasive bladder cancer is an unforgiving disease, and if untreated, it leads to death within 2 years of the diagnosis in >85 % of the patients. Long-term oncologic efficacy remains the ultimate standard that all procedures have to be measured by. In the past decades, open radical cystectomy (RC), extended pelvic lymph node dissection (PLND), and urinary diversion have been established as the gold standard. In the last few years, however, growing attention has been set on robotic-assisted radical cystectomy (RARC).
  
  
  RESULTS
  Even in the very long term, open RC has good oncological results and if an ileal neobladder is performed excellent functional results. Follow-up of patients after open RC exceeds more than a decade which is unsurpassed by any other technique. Its outcomes have been proven to be durable and cost-effective. Least perioperative complications as well as best oncological and functional results can be achieved if open RC and urinary diversion were performed in a high-volume hospital by high-volume surgeons and an experienced team.
  
  
  CONCLUSIONS
  Despite upcoming new technologies such as RARC, open RC following extended (PLND) remains the gold standard treatment for high-grade muscle invasive bladder cancer.
authors.affiliation: Department of Urology, University of Bern, 3010, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kiss
authors.affiliation: Department of Urology, University of Bern, 3010, Bern, Switzerland.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.affiliation: Department of Urology, University of Bern, 3010, Bern, Switzerland. George.thalmann@insel.ch.
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D061847:Hospitals, High-Volume; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D009130:Muscle, Smooth / Q000473:pathology; D009361:Neoplasm Invasiveness; D010388:Pelvis; D011183:Postoperative Complications; D059039:Standard of Care; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Muscle invasive bladder cancer; Open radical cystectomy