Introduction & Objectives
The complexity of bladder cancer diagnosis and staging results in delays to definitive treatment of muscle-invasive bladder cancer by radical cystectomy. This systematic review and meta-analyses aim to assess the impact of delays to radical cystectomy.
Materials & Methods
A systematic review was conducted by searching Medline and Ovid Gateway using protocol-driven search terms with no time limit on the studies included. The identified studies were assessed according to strict criteria and were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and Risk Of Bias In Non-randomised Studies – of Interventions (ROBINS-I) tool. Meta-analyses were conducted based on type of delay. Random-effects models were used whereby the presence of a delay was the exposure variable and overall survival was the outcome of interest, for which pooled hazard ratios were calculated.
Results
Nineteen studies were eligible for inclusion (17,532 patients), of which ten were included in the meta-analyses. A longer delay between bladder cancer diagnosis and radical cystectomy resulted in a pooled hazard ratio of 1.34 (95% CI: 1.18-1.53) for overall death. For delay between transurethral resection and cystectomy, we found a pooled hazard ratio of 1.18 (95% CI: 0.99-1.41) for overall death. A pooled hazard ratio of 1.04 (95%CI: 0.93-1.16) was calculated for a longer delay between neoadjuvant chemotherapy and radical cystectomy. 
Conclusions
A delay in radical cystectomy after diagnosis was found to have a significantly detrimental effect on overall survival for bladder cancer patients. However, there was huge heterogeneity in how a delay was defined. This review highlights the importance of scheduling radical cystectomies in a timely manner whilst monitoring factors such as comorbidities and scheduling in order treat those patients requiring radical cystectomy without delay.

A systematic review and meta-analysis of delay to radical cystectomy and the effect on survival in bladder cancer patients