Neoadjuvant chemotherapy (NAC) prior to radical cystectomy is associated with higher rates of bleeding and sepsis, but not major complications or mortality, investigators reported at the American Society of Clinical Oncology’s 2023 Genitourinary Cancers Symposium in San Francisco, California.

Using 2019-2020 data from the National Surgical Quality Improvement Program (NSQIP) database, Rishabh Kumar Simhal, MD, of Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and colleagues studied 4482 patients who underwent radical cystectomy, of whom 1889 (42%) received NAC.

Compared with patients who had a radical cystectomy alone, those who received NAC plus radical cystectomy were significantly younger (66.9 vs 70.4 years), were significantly more likely to have a robotic procedure (23% vs 19%), and had a significantly shorter hospital length of stay (7.1 vs 7.8 days), Dr Simhal reported on behalf of his team. They also were more likely to have pT0 tumors (18.4% vs 5.9%).

Continue Reading

On multivariable analysis, the NAC group had significant 1.8-fold higher odds of bleeding requiring transfusion compared with the cystectomy-only group, according to the investigators. The NAC group had significant 1.4-fold higher odds of sepsis, but otherwise did not differ from the cystectomy-only group in major complications.

Dr Simhal and colleagues noted that the higher risks for bleeding and sepsis may be related to the immunosuppressive effects of chemotherapeutics.

The investigators found no difference in 30-day need for reoperation, readmission, or mortality.


Simhal RK, Wang KR, Shah Y, et al. Impact of neoadjuvant chemotherapy on 30-day radical cystectomy outcomes. Presented at: ASCO GU 2023, San Francisco, California, February 16-18. Abstract 575.