Perioperative Complications After Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer

Introduction: Few data on the perioperative outcomes of cystectomy after neoadjuvant chemotherapy (NAC) exist. In this study, we evaluated whether patients who had previously received NAC were at higher risk of developing perioperative complications.

Materials And Methods: The National Surgical Quality Improvement Program (NSQIP) database was searched to identify cystectomies performed between January 1, 2005 and December 31, 2011. Of 1394 patients identified, about one-tenth (n = 122 [8.8%]) received NAC. A propensity-weighted comparative analysis of perioperative morbidity was conducted.

Results: In unadjusted comparisons, patients undergoing cystectomy after NAC were more likely to have peripheral nerve deficits (1.6% [2/122] versus 0.2% [3/1272]; p = .01), blood transfusions (37.7% [46/122] versus 27.5% [350/1272]; p = .02), and unplanned readmissions (11.5% [14/122] versus 6.6% [84/1272]; p = .04), but were less likely to require hospitalization longer than 8 days (45.1% [55/122] versus 58.8% [748/1272]; p = .01). Propensity-weighted adjustments showed that cystectomy after NAC produced little increased risk of perioperative surgical complications except for peripheral nerve deficits (3.2% [4/122] versus 0.3% [3/1166]; propensity score-adjusted odds ratio [PS-OR], 13.1; 95% CI, 1.90-90.8; p = .01) and resulted in better rates of wound dehiscence (0.8% [1/122] versus 3.3% [38/1166]; PS-OR, 0.20; 95% CI, 0.04-0.89; p = .04) and sepsis (4.9% [6/122] versus 11.4% [134/1166]; PS-OR, 0.36; 95% CI, 0.17-0.76; p = .01). No differences in 30 day mortality were noted.

Conclusions: NAC is not associated with perioperative complications after cystectomy. As expected, there was an increase in peripheral nerve deficits in the neoadjuvant chemotherapy group, but this was likely due to the known neurotoxicity of the cisplatin agents.