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Multicenter Study
. 2020 Feb;38(2):381-388.
doi: 10.1007/s00345-019-02770-2. Epub 2019 Apr 24.

No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study

Tomas Jerlström  1 , Ruoqing Chen  2   3 , Fredrik Liedberg  4   5 , Ove Andrén  1 , Viveka Ströck  6   7 , Firas A S Aljabery  8 , Abolfazl Hosseini  9 , Amir Sherif  10 , Per-Uno Malmström  11 , Anders Ullén  12 , Truls Gårdmark  13 , Katja Fall  14   15
Affiliations
Multicenter Study

No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study

Tomas Jerlström et al. World J Urol. 2020 Feb.

Abstract

Purpose: Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking.

Methods: We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not.

Results: Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82-1.39) or mortality (OR 0.75 95% CI 0.36-1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30-0.81).

Conclusion: This nation-wide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.

Keywords: Bladder cancer; Induction chemotherapy; Neoadjuvant chemotherapy; Postoperative complications; Radical cystectomy.

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Conflict of interest statement

The authors have declared no potential conflicts of interest.

References

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