Radical cystectomy (RC) is one of the most important treatments for bladder cancer. However, for many years, patients undergoing RC have not seen a substantial improvement in prognosis. In recent years, there has been a glimmer of hope for RC patients due to optimized treatment of high-risk stage T1 bladder cancer, chemotherapy in the perioperative period, and the use of robotics. A concise review of research advances in RC and adjuvant/neoadjuvant chemotherapy in 2015 by Professor Witjes of the Netherlands was published recently in Nature Reviews Urology. Topic 1: When to perform RC and what is the best procedure? For patients with non-muscle invasive bladder cancer (NMIBC), the question of which patients need RC sooner rather than electrodesiccation and bladder irrigation is a major concern for urologists. It has been shown that those who progress from NMIBC to muscle-invasive bladder cancer (MIBC) have a tumor-specific mortality rate (CSM) that is twice as high as those who have MIBC at the time of initial diagnosis. Therefore, early identification of high-risk patients with NMIBC will be the next research priority in urology. A retrospective analysis this year summarized the many factors that affect the prognosis of patients with T1NMIBC. It was found that the depth of cancer infiltration in the submucosa is an important indicator of disease progression and CSM. In addition, the presence of carcinoma in situ, pre-existing lymphovascular infiltration, failure to use BCG, larger tumors, and older age were all suggestive of a worse prognosis. This result suggests the possibility of early RC treatment for patients with high-risk prognostic factors. Assuming the patient has decided to undergo RC, the question arises as to whether the traditional gold standard of open radical cystectomy (ORC) or the emerging robotic-assisted radical cystectomy (RARC) should be chosen. Prof. Novara et al. systematically evaluated both procedures and found that although RARC had a longer operative time of 1-2 hours than ORC, blood loss was less, hospital days were 1-1.5 days shorter, and there were fewer low-grade complications than ORC. However, due to the poor quality of the literature included in this systematic evaluation, Professor Witjes believes that the level of evidence obtained from this literature is also low. The results of a similar RCT conducted by Prof. Bochner et al. were more convincing. In this study, 60 patients underwent RARC and 58 patients underwent ORC. There was no difference in complications between the two procedures at 90 days postoperatively, but the RARC group lost less blood than ORC. However, the cost of the RARC procedure itself was higher, which somewhat reduced the benefits of this procedure. Based on these findings, Prof. Witjes noted that RARC may be able to outperform ORC, regardless of the economic factors, but emphasized that the clinical experience and surgical skill of a surgeon is the key to the real benefit of both RARC and ORC. Topic 2: Use and efficacy of adjuvant/neoadjuvant chemotherapy in patients receiving RC To minimize delay, urologists usually prefer RC to neoadjuvant chemotherapy. However, according to Prof. Reardon et al, the use of chemotherapy in the perioperative period increased by 40% between 2006 and 2010, with a predominance of neoadjuvant chemotherapy. According to Prof. Svatek et al, neoadjuvant chemotherapy can benefit high-risk MIBC patients (T ≥ 3 or N+) who already have RC, with a 5-year survival rate of 32.8%. As to which neoadjuvant chemotherapy regimen is superior, some studies suggest that there is no difference between MAVC (methotrexate, vincristine, adriamycin and cisplatin) and GC (gemcitabine and cisplatin) regimens. An article published by Professor Sternberg et al. compared the survival of two groups with adjuvant chemotherapy immediately after RC surgery (141 cases) and delayed adjuvant chemotherapy (143 cases). After 5.2-8.7 years of follow-up, the 5-year progression-free (PFS) rate was significantly better in the immediate adjuvant chemotherapy group than in the delayed group (47.6% vs. 31.8%). The study also found that the incidence of toxic side effects such as myelosuppression was also higher in the delayed group. This is in line with current guidelines that suggest that early adjuvant chemotherapy improves the prognosis of patients. In conclusion, Professor Witjes concluded that every small step forward in research on RC and perioperative chemotherapy this year is a big step forward for the field of bladder cancer. We also look forward to more new breakthroughs for bladder cancer patients this time next year.