Complications associated with single-dose, perioperative mitomycin-C for patients undergoing bladder tumor resection

Abstract

Objectives: To better understand the risk of short-term complications associated with perioperative intravesical mitomycin-C (MMC) therapy for patients undergoing endoscopic management of non-muscle invasive bladder cancer.

Methods and materials: Using an institutional database of patients with bladder cancer, we performed a retrospective case-control study of patients receiving perioperative MMC after tumor resection (2008-2012). MMC cases were matched by clinical stage to controls receiving endoscopic resection alone. Demographic information, clinicopathologic details, and outcomes were compared between groups. Outcomes of interest included overall, genitourinary, and major complications. Chi-square tests and multivariable logistic regression were used to evaluate associations among patient characteristics, clinical factors, exposure to MMC, and outcomes of interest.

Results: One-hundred sixteen patients treated with MMC were matched to 116 controls. Patients receiving MMC were younger (P = 0.04) and more likely to have invasive disease (i.e. T1 or greater) (23% vs. 15%, P = 0.02). Complications were more frequent among patients who were treated with MMC (34.5% vs. 19.8%, Odds Ratio 2.89, 95% Confidence Interval 1.43-5.81). The most common complication among MMC patients that required medical management was dysuria (17%). Major complications were more common among MMC patients (5.2% vs. 0.9%), but this difference did not reach statistical significance (P = 0.11).

Conclusions: Use of MMC is associated with a greater odds of complications compared with controls. Patients should be counseled regarding both the benefits and potential risks of perioperative intravesical MMC. Continued research is required to understand the safety implications associated with the use of perioperative, intravesical MMC.

Keywords: Bladder cancer; Chemotherapy; Complications; Mitomycin; Safety.

Figure 1

Complications associated with perioperative intravesical mitomycin-C (MMC), stratified by severity. This figure demonstrates the proportion of patients that experienced complications, based on whether or not they received perioperative MMC at the time of resection. The y-axis is the percentage of cases that experienced complications. The x-axis portrays the subgroups of complication types (i.e., overall, minor, and major). Minor complications are those with Clavien classification less than or equal to two. Major complications were defined as those with Clavien classification three or greater. The black bars represent patients who received MMC, and the grey bars signify the patients who were not treated with MMC.