Neoadjuvant chemotherapy does not increase peri-operative morbidity following radical cystectomy.

Abstract

OBJECTIVE:

To determine whether use of neoadjuvant chemotherapy (NAC) is associated with a higher risk of post-operative complications following radical cystectomy (RC) for bladder cancer (BCa).

MATERIALS AND METHODS:

We retrospectively reviewed records of patients undergoing RC for non-metastatic urothelial BCa at 13 tertiary care centres from 2007-2019. Patients who received NAC ('NAC + RC' group) were compared with those who underwent upfront RC ('RC alone' group) for intra-operative variables, incidence of post-operative complications as per the Clavien-Dindo classification (CDC) and rates of re-admission and re-intervention. Multivariable logistic regression analysis was performed to determine predictors of CDC overall and CDC major (grade III-V) complications. We also analysed the trend of NAC utilization over the study period.

RESULTS:

Of the 3113 patients included, 968 (31.1%) received NAC while the remaining 2145 (68.9%) underwent upfront RC for BCa. There was no significant difference between the NAC + RC and RC alone groups with regards to 30-day CDC overall (53.2% vs 54.6%, p = 0.4) and CDC major (15.5% vs 16.5%, p = 0.6) complications. The two groups were comparable for the rate of surgical re-intervention (14.6% in each group) and re-hospitalization (19.6% in NAC + RC vs 17.9% in RC alone, p = 0.2%) at 90 days. On multivariable regression analysis, NAC use was not found to be a significant predictor of 90-day CDC overall (OR 1.02, CI 0.87-1.19, p = 0.7) and CDC major (OR 1.05, CI 0.87-1.26, p = 0.6) complications. We also observed that the rate of NAC utilization increased significantly (p < 0.001) from 11.1% in 2007 to 41.2% in 2019, reaching a maximum of 48.3% in 2018.

CONCLUSION:

This large multicentre analysis with a substantial rate of NAC utilization showed that NAC use does not lead to an increased risk of post-operative complications following RC for BCa. This calls for increasing NAC use to allow patients to avail of its proven oncologic benefit.

• Authors: Amandeep Arora, Ahmed S Zugail, Felipe Pugliesi, Xavier Cathelineau, Petr Macek, Yann Barbé, R Jeffrey Karnes, Mohamed Ahmed, Ettore Di Trapani, Francesco Soria, Mario Alvarez-Maestro, Francesco Montorsi, Alberto Briganti, Andrea Necchi, Benjamin Pradere, David D'Andrea, Wojciech Krajewski, Mathieu Roumiguié, Anne Sophie Bajeot, Rodolfo Hurle, Roberto Contieri, Roberto Carando, Jeremy Yuen-Chun Teoh, Morgan Roupret, Daniel Benamran, Guillaume Ploussard, M Carmen Mir, Rafael Sanchez-Salas, Marco Moschini
• Journal: World journal of urology (World J Urol) Vol. 40 Issue 7 Pg. 1697-1705 (Jul 2022) ISSN: 1433-8726 [Electronic] Germany
• PMID: 35488914 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Chemotherapy, Adjuvant
• Cystectomy (adverse effects)
• Humans
• Morbidity
• Neoadjuvant Therapy
• Postoperative Complications (etiology)
• Retrospective Studies
• Urinary Bladder Neoplasms (drug therapy, pathology, surgery)