Impact of neoadjuvant chemotherapy on complications of minimally invasive radical cystectomy

Neoadjuvant chemotherapy (NC) before minimally invasive radical cystectomy (MIRC) is considered a standard of care in muscle-invasive bladder cancer or recurrent high-risk non-muscle-invasive bladder cancer.

To evaluate the impact of NC on morbidity and mortality after MIRC.

We prospectively evaluated 135 patients who underwent MIRC (laparoscopic: n=100; robotic: n=35) between 2007 and 2013 with ≥90 days of follow-up (median age: 66 year). Complications were analyzed and graded according to the Clavien Dindo classification system.

Logistic regression models were used to evaluate the impact of NC on postoperative complications. Kaplan-Meier methods with the log-rank test were used for cancer-specific survival probabilities and differences between the 2groups (MIRC with and without NC).

Sixty-two of 135 patients received NC. A total of 118 patients (87.4%) developed 179 complications, chiefly infectious (48.0%) or gastrointestinal (21.2%), ≤90 days after surgery; 3 patients died <90 days after cystectomy (none had NC). NC had no impact on the incidence of postoperative complications but was associated with fewer positive nodes (P=.004) compared with patients without NC. The median duration of follow-up was 17.2 months. Overall survival rates were 83% and 79% at 2 year in patients with NC and without NC, respectively.

NC does not affect postoperative morbidity or postoperative mortality. Longer follow-up is needed to evaluate the impact of NC on oncologic outcomes.

Perioperative complications of radical cystectomy were compared for patients with bladder cancer who had NC versus no NC. We did not find any significant differences in terms of early or late complications, length of stay, or reintervention. The oncologic outcomes regarding NC were encouraging.