Surgical Treatment Options for Metastatic Bladder Cancer

For people living with metastatic bladder cancer, surgery is increasingly recognized as a valuable tool not to cure the disease, but to manage symptoms, improve quality of life, and support other treatments. While systemic therapies like chemotherapy and immunotherapy remain central to care, surgical interventions can play a meaningful role in specific cases, particularly when tumors cause pain, bleeding, or urinary blockages.

According to Dr. Nitin Yerram, a urologic oncologist and co-director of urologic oncology at Hackensack Meridian John Theurer Cancer Center in New Jersey, the goal of surgery in metastatic bladder cancer is not always to eliminate cancer but to alleviate discomfort and prevent complications. “Any surgery for metastatic bladder cancer can work as palliative care,” he explains, noting that procedures aim to improve quality of life by reducing painful or debilitating symptoms.

One common palliative option is radical cystectomy, the removal of the entire bladder and nearby lymph nodes. This procedure can relieve symptoms such as pain during urination and blood in the urine that do not respond to medication. It may also help prevent fistulas — abnormal openings between organs, such as between the bladder and vagina — which can cause infection and significant discomfort. After bladder removal, surgeons create a new pathway for urine to leave the body through urinary diversion techniques, including urostomy (using a segment of intestine to route urine to an external bag) or a bladder substitute that allows for more natural urination.

Another surgical approach, cytoreductive surgery, focuses on removing visible tumors and surrounding tissue. In metastatic bladder cancer, this often begins with a transurethral resection of bladder tumor (TURBT), a minimally invasive procedure where instruments are inserted through the urethra to remove bladder growths without external incisions. For tumors that have spread beyond the bladder — such as to the lymph nodes, lungs, or abdominal lining — more extensive surgery may be needed. When cancer has metastasized to a limited number of sites, a procedure called metastasectomy may be considered.

Metastasectomy involves removing one or more metastatic tumors from other parts of the body. Dr. Yerram notes that this approach may improve survival in patients with oligometastatic disease — meaning a small number of metastases — especially if they have responded well to prior chemotherapy. In rare cases, complete removal of solitary lung metastases has led to long-term disease-free survival. Beyond survival benefits, metastasectomy can also relieve symptoms; for example, removing a lung tumor may ease chronic cough and pain associated with coughing.

Surgery is not appropriate for everyone with metastatic bladder cancer. The decision is highly individualized and made by a multidisciplinary team that may include a surgeon, medical oncologist, and radiation oncologist. Key factors considered include the patient’s overall health, the location and number of metastatic tumors, and how well the cancer has responded to other treatments such as chemotherapy or immunotherapy. Doctors also evaluate whether the patient might be eligible for clinical trials exploring new drug combinations, immunotherapies, or the optimal timing of surgery.

As with any major surgery, risks include bleeding, infection, blood clots, and reactions to anesthesia. Procedure-specific complications vary: radical cystectomy may lead to erectile dysfunction in men or vaginal discomfort and sexual arousal difficulties in women, while metastasectomy in the lungs carries risks such as pneumonia or breathing problems. Surgical teams discuss these potential outcomes with patients and provide guidance on recovery and side effects to monitor.

Although surgery has not traditionally been a first-line option for metastatic bladder cancer, growing evidence suggests it can help some patients live longer and experience better symptom control when integrated into a broader treatment plan. As Dr. Yerram emphasizes, “The decision to pursue surgery is highly individualized and made by a multidisciplinary team.” Patients are encouraged to ask their care team about all available options, including surgical pathways and clinical trial opportunities, to make informed choices aligned with their goals and values.