Radical cystectomy bladder preservation distant metastasis rate (DMR) muscular invasive bladder cancer (MIBC) survival rate form (available at https://dx.doi.org/10.21037/tau-21-564). The authors have no conflicts of interest to declare.

Antineoplastic Combined Chemotherapy Protocols/*therapeutic use Carcinoma Transitional Cell/*drug therapy/pathology Clinical Trials Phase II as Topic Clinical Trials Phase III as Topic Humans Neoplasm Metastasis Neoplasm Staging Practice Guidelines as Topic Randomized Controlled Trials as Topic Urinary Bladder Neoplasms/*drug therapy/pathology Immune checkpoint inhibitors Platinum-based chemotherapy Survival outcomes Treatment guidelines Urothelial carcinoma funded this work. MK PK and SD are employees of Evidera.

Administration Intravesical Antineoplastic Agents/*administration & dosage/adverse effects Clinical Trials as Topic Disease Progression Humans Neoplasm Metastasis *Neoplasm Recurrence Local Network Meta-Analysis Progression-Free Survival Risk Assessment Risk Factors Time Factors Urinary Bladder Neoplasms/*drug therapy/mortality/pathology

Carcinoma Transitional Cell/secondary/*surgery Cystectomy/*adverse effects/methods Humans *Lymphatic Metastasis Neoplasm Recurrence Local/*epidemiology Peritoneal Neoplasms/epidemiology/*secondary Robotic Surgical Procedures/*adverse effects/methods Urinary Bladder Neoplasms/pathology/*surgery Atypical recurrence Bladder cancer Cystectomy Port-site metastases Rarc

Coloring Agents Humans Indocyanine Green Lymph Node Excision *Lymphatic Metastasis/diagnostic imaging *Lymphography Male Pelvis *Prostatic Neoplasms/diagnostic imaging/pathology Sentinel Lymph Node Biopsy *Urinary Bladder Neoplasms/diagnostic imaging/pathology Cáncer de Próstata Ganglio centinela Linfadenectomía Lymph node dissection Prostate cáncer Sentinel lymph node Verde de Indocianina

Carcinoma Transitional Cell/*diagnostic imaging/pathology/surgery Cystectomy Humans Lymph Nodes/*diagnostic imaging/pathology Lymphatic Metastasis/diagnostic imaging Magnetic Resonance Imaging Neoplasm Staging Positron Emission Tomography Computed Tomography Sensitivity and Specificity Tomography X-Ray Computed Urinary Bladder Neoplasms/*diagnostic imaging/pathology/surgery Bladder cancer Computed tomography Positron emission tomography Transitional cell carcinoma

Cystectomy/methods/*mortality Humans Lymph Node Excision/methods/*mortality Lymph Nodes/surgery Lymphatic Metastasis Pelvis/pathology Postoperative Complications/etiology Prognosis Randomized Controlled Trials as Topic Survival Rate Treatment Outcome Urinary Bladder Neoplasms/*mortality/pathology/*surgery

Abdominal Muscles/*physiopathology Female *Health Services Needs and Demand Humans Middle Aged Neoplasm Metastasis/*physiopathology Quality of Life/*psychology *Social Support Urinary Bladder Neoplasms/*psychology/*secondary/therapy Bladder cancer Concerns Continent diversion Quality of life Systematic review Unmet supportive care needs

Databases Factual Disease-Free Survival Humans Lymphocytes/*cytology/immunology Neoplasm Metastasis Neutrophils/*cytology/immunology Odds Ratio Prognosis Proportional Hazards Models Risk Assessment Survival Rate Urinary Bladder Neoplasms/immunology/mortality/*pathology Urologic Neoplasms/immunology/mortality/*pathology Bladder cancer Metastatic unresectable urothelial carcinoma Neutrophil-Lymphocyte ratio Unresectable urothelial carcinoma

Contrast Media Diagnosis Differential Female Humans Lymphatic Metastasis/*diagnostic imaging/pathology Magnetic Resonance Imaging/*methods Male Prostatic Neoplasms/*pathology Sensitivity and Specificity Urinary Bladder Neoplasms/*pathology Mri bladder cancer lymph node metastasis meta-analysis prostate cancer

Cystectomy/*adverse effects Humans Lymphatic Metastasis Neoplasm Invasiveness Neoplasm Recurrence Local/etiology/*pathology Urinary Bladder Neoplasms/pathology/*surgery Vascular Neoplasms/etiology/*pathology Bladder cancer Lymph node dissection Lymphovascular invasion Meta-analysis Metastasis Radical cystectomy

Chemoradiotherapy/*methods Combined Modality Therapy Cystectomy/*adverse effects/methods Disease-Free Survival Female Humans Male Middle Aged Neoplasm Metastasis Robotic Surgical Procedures/*adverse effects/methods Treatment Outcome Urinary Bladder Neoplasms/diagnostic imaging/*therapy Bladder cancer Cystectomy Multi-modality treatment Port-site metastasis Rare complications

*Acetates *Carbon Carbon Radioisotopes Carcinoma Transitional Cell/*diagnostic imaging/pathology *Choline Humans Likelihood Functions Lymph Nodes/*diagnostic imaging/pathology Lymphatic Metastasis Neoplasm Staging Odds Ratio Positron Emission Tomography Computed Tomography ROC Curve Sensitivity and Specificity Urinary Bladder Neoplasms/*diagnostic imaging/pathology Bladder cancer C-11 acetate C-11 choline Lymph node Pet/ct Staging

Humans *Lymph Node Excision Lymphatic Metastasis Muscle Smooth/pathology Neoplasm Invasiveness Prognosis Urinary Bladder Neoplasms/pathology/*surgery Cáncer vesical con infiltración de la muscular Linfadenectomía Lymph node anatomical territory Lymphadenectomy Muscle invasive bladder cancer Oncological value Territorios anatómicos ganglionares Valor oncológico

Clinical Decision-Making Cystectomy/*methods Cytoreduction Surgical Procedures/methods Humans *Neoplasm Metastasis/pathology/therapy Practice Guidelines as Topic Treatment Outcome *Urinary Bladder Neoplasms/pathology/surgery Bladder cancer Lymph node dissection Lymph node metastasis Metastasectomy Metastatic bladder cancer Surgery interest including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg employment/affiliation grants or funding consultancies honoraria stock ownership or options expert testimony royalties or patents filed received or pending) are the following: None.

Fluorodeoxyglucose F18 Humans Lymph Nodes/*diagnostic imaging/pathology Lymphatic Metastasis/diagnosis/*diagnostic imaging/pathology Neoplasm Staging/methods Positron Emission Tomography Computed Tomography/*methods ROC Curve Sensitivity and Specificity Urinary Bladder Neoplasms/*diagnostic imaging/pathology/surgery Bladder cancer F-18 fluorodeoxyglucose Lymph node Positron emission tomography/computed tomography Staging

Cystectomy/*methods Disease-Free Survival Humans Lymphatic Metastasis *Margins of Excision Neoplasm Recurrence Local Neoplasm Staging Prognosis Treatment Outcome Urinary Bladder Neoplasms/pathology/*surgery bladder cancer meta-analysis outcome radical cystectomy surgical margin status

Humans Lymph Node Excision Lymph Nodes/*pathology Lymphatic Metastasis/pathology Prognosis Urinary Bladder Neoplasms/diagnosis/*pathology/*therapy

Cystectomy/*methods Humans Lymph Node Excision Lymph Nodes/*pathology Lymphatic Metastasis/*diagnosis Urinary Bladder Neoplasms/*pathology/*surgery

Adult Aged Aged 80 and over Antibodies Monoclonal/therapeutic use Antibodies Monoclonal Humanized/therapeutic use B7-H1 Antigen/*antagonists & inhibitors/genetics CTLA-4 Antigen/*antagonists & inhibitors/genetics Clinical Trials as Topic Female Genes cdc/drug effects Humans Ipilimumab Male Middle Aged Neoplasm Metastasis/*drug therapy/genetics/pathology Nivolumab Urinary Bladder Neoplasms/*drug therapy/genetics/pathology Bladder cancer immunotherapy Checkpoint inhibitor Pembrolizumab