Assessing neoadjuvant chemotherapy's impact on complications following radical cystectomy

Abstract

Introduction: Despite level 1 evidence supporting neoadjuvant chemotherapy (NACT) followed by radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC), its adoption is hindered by concerns about toxicity and detrimental impact on post-RC complications. We retrospectively reviewed post-RC complications at a tertiary care hospital, particularly assessing impact of NACT.

Methods: Data from the institutional bladder cancer database were retrieved for patients aged ≥18 with MIBC (≥American Joint Committee on Cancer Clinical Stage T2), treated with RC between May 2013 and July 2023. Exclusions were nonurothelial histology, salvage cystectomy, and palliative intent. Data abstracted included patient characteristics, NACT administration, surgery, and outcomes. Patients were divided into two groups based on NACT and compared. Complications were categorized as early (≤30 days) or late (31-90 days) and graded. Statistical analysis set significance at P < 0.05.

Results: Of 154 patients who underwent RC, 33 were excluded due to non-MIBC, nonurothelial histology, or salvage cystectomy. The 121 patients analyzed had a mean age of 64 years and a Charlson Comorbidity Index (CCI) of 4.9. Among them, 61 received NACT and 60 did not. There was no significant difference between the NACT+RC and RC-only groups in overall complication rates (85.3% vs. 75.0%, P = 0.16) or in major complications (50.8% vs. 58.3%, P = 0.41). CCI >5 predicted major complications, while NACT did not.

Conclusion: In our study of MIBC patients managed at a tertiary care institute in India, NACT administration did not increase postoperative complications.

Figure 1

STROBE flowchart. Flowchart of patient inclusion, exclusion and study design