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. 2022 Jul;40(7):1697-1705.
doi: 10.1007/s00345-022-04012-4. Epub 2022 Apr 30.

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

Amandeep Arora  1   2 , Ahmed S Zugail  3   4 , Felipe Pugliesi  3   5 , Xavier Cathelineau  3 , Petr Macek  3 , Yann Barbé  3 , R Jeffrey Karnes  6 , Mohamed Ahmed  6 , Ettore Di Trapani  7 , Francesco Soria  8 , Mario Alvarez-Maestro  9   10 , Francesco Montorsi  11 , Alberto Briganti  11 , Andrea Necchi  12 , Benjamin Pradere  13 , David D'Andrea  13 , Wojciech Krajewski  14 , Mathieu Roumiguié  15 , Anne Sophie Bajeot  15 , Rodolfo Hurle  16 , Roberto Contieri  16 , Roberto Carando  17 , Jeremy Yuen-Chun Teoh  18 , Morgan Roupret  19 , Daniel Benamran  19   20 , Guillaume Ploussard  21 , M Carmen Mir  22 , Rafael Sanchez-Salas  3 , Marco Moschini  3   11
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Neoadjuvant chemotherapy does not increase peri-operative morbidity following radical cystectomy

Amandeep Arora et al. World J Urol. 2022 Jul.

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.

Keywords: Bladder cancer; Clavien–Dindo classification; Complications; Neoadjuvant chemotherapy; Radical cystectomy; Urothelial cancer.

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