Neoadjuvant chemotherapy for bladder cancer does not increase risk of perioperative morbidity

Authors

  • David C. Johnson,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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  • Matthew E. Nielsen,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
    3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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  • Jonathan Matthews,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
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  • Michael E. Woods,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
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  • Eric M. Wallen,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
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  • Raj S. Pruthi,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
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  • Matthew I. Milowsky,

    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
    3. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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  • Angela B. Smith

    Corresponding author
    1. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    2. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA
    • Correspondence: Angela B. Smith, University of North Carolina, Department of Urology, 170 Manning Drive, 2113 Physicians Office Building, CB#7235, Chapel Hill, NC 27599-7235, USA.

      e-mail: angela_smith@med.unc.edu

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  • Details of all funding sources for work in question: The project described was supported by the University Cancer Research Fund and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grants KL2TR001109 and UL1TR001111.

Abstract

Objective

To determine whether neoadjuvant chemotherapy (NAC) is a predictor of postoperative complications, length of stay (LOS), or operating time after radical cystectomy (RC) for bladder cancer.

Patients and Methods

A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed to identify patients receiving NAC before RC from 2005 to 2011. Bivariable and multivariable analyses were used to determine whether NAC was associated with 30-day perioperative outcomes, e.g. complications, LOS, and operating time.

Results

Of the 878 patients who underwent RC for bladder cancer in our study, 78 (8.9%) received NAC. Excluding those patients who were ineligible for NAC due to renal insufficiency, 78/642 (12.1%) received NAC. In all, 457 of the 878 patients (52.1%) undergoing RC had at least one complication ≤30 days of RC, including 43 of 78 patients (55.1%) who received NAC and 414 of 800 patients (51.8%) who did not (P = 0.58). On multivariable logistic regression, NAC was not a predictor of complications (P = 0.87), re-operation (P = 0.16), wound infection (P = 0.32), or wound dehiscence (P = 0.32). Using multiple linear regression, NAC was not a predictor of increased operating time (P = 0.24), and patients undergoing NAC had a decreased LOS (P = 0.02).

Conclusions

Our study is the first large multi-institutional analysis specifically comparing complications after RC with and without NAC. Using a nationally validated, prospectively maintained database specifically designed to measure perioperative outcomes, we found no increase in perioperative complications or surgical morbidity with NAC. Considering these findings and the well-established overall survival benefit over surgery alone, efforts are needed to improve the uptake of NAC.

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