Chemotherapy prior to radical cystectomy (RC) for bladder cancer does not increase the risk of perioperative complications, according to researchers.


A team led by Angela B. Smith, MD, of the University of North Carolina at Chapel Hill, analyzed data from 878 patients who underwent RC for muscle-invasive bladder cancer (MIBC). Of these, 78 (8.9%) received neoadjuvant chemotherapy (NAC). The proportion rose to 12.1% when the investigators excluded patients who were ineligible to receive NAC because of renal insufficiency.

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Overall, 457 (52.1%) of the 878 patients had at least one complication in 30 days or less following surgery, including 43 (55.1%) of the 78 patients who received NAC and 414 (51.8%) of 800 patients who did not receive NAC, Dr. Smith and colleagues reported online ahead of print in BJU International.


On multivariate analysis, NAC was not associated with complications overall or with re-operations, wound infection, or wound dehiscence. NAC also was not associated with increased operating time, but it was associated with a significant decrease in hospital length of stay (mean 9.3 days vs. 11.3 days for patients who did not receive NAC).


Dr. Smith’s group noted that clinical guidelines recommend “strongly considering” the use of NAC before patients with muscle-invasive bladder cancer undergo radical cystectomy. Despite this recommendation, NAC before radical cystectomy remains underused, they stated. One possible reason is concern about increased perioperative complications in patients with MIBC.


“Considering these findings and the well-established overall survival benefit over surgery alone, efforts are needed to improve the uptake of NAC,” the authors concluded.


For the study, the investigators used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The absence of certain information in the database was among the study limitations.


The database lacked of pathologic data, so it was not possible to account for the effect of extent of disease on complications or exclude patients who underwent RC for non-MIBC other than carcinoma in situ, for which NAC is not indicated, the authors explained. “The latter could therefore result in an underestimation of the true use of NAC.”


Also absent from the database was information on surgical technique, whether pelvic lymph node dissection or removal of adjacent organs was performed, or type of urinary diversion.


“Chemotherapeutic regimen or number of cycles completed is unknown, which could certainly affect outcomes,” the researchers observed.