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Título

NEOADJUVANT CHEMOTHERAPY DOES NOT INCREASE PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY WITH PELVIC LYMPH NODE DISSECTION – A CALL FOR INCREASED USE

Introdução, Material, Método, Resultados, Discussão e Conclusões

Introduction:Neoadjuvant cisplatin-based combination chemotherapy (NAC) followed by radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) is the standard of care in treating cT2-T4a urothelial bladder cancer (BCa) patients. In spite of this,most contemporary series report underutilization of NAC.This may be attributed to fear of increased toxicity & peri-operative morbidity with NAC.Our objective was to determine whether NAC is associated with increased perioperative complications after RC
Materials & methods: We retrospectively reviewed patients undergoing RC at our center from January 2007 to July 2019.Only patients undergoing RC for cT2-T4a urothelial BCa were included and were grouped into those undergoing RC alone & those receiving NAC followed by RC.Data was collected for preoperative, intraoperative & postoperative variables.Complications were graded as per the Clavien Dindo Classification (CDC) & divided into low grade (CDC 1,2) & high grade (CDC>3).Multivariable logistic regression was used to check whether NAC delivery was associated with postoperative complications
Results:303 patients underwent RC with PLND in our centre,of which 240 were performed for cT2-T4a urothelial BCa.Of these,72 (30%) underwent RC alone while 168 (70%) received NAC followed by RC.Of the 72 patients undergoing RC alone, 12 (16.67%) were cisplatin-ineligible.Utilization of NAC at our centre has been 76.5% since 2008 & has increased to 81.2% in the last 5 years.Patients receiving NAC were younger (66.5 vs 72 years, p<0.005) & had a better Charlson Comorbidity Index (2 vs 3, p=0.02) compared to those undergoing RC directly.The median operating time (270 vs 240 min, p=0.005) was longer & the blood loss (600 vs 500 ml, p=0.01) was higher in the NAC group.No significant differences were observed in the NAC + RC & RC alone groups with regards to overall (70.6% vs 68.5%), low grade (65.2% vs 64%) & high grade (34.7% vs 36%) CDC complications (all p>0.1) & length of hospital stay (p=0.12).On multivariable logistic regression,NAC was not associated with postoperative complications, rehospitalization & reintervention
Conclusion:Utilization of NAC is much greater at our centre than that reported in contemporary series.Our results show that,apart from increased operating time & blood loss,NAC is not associated with increased peri-operative complications after RC with PLND,presenting a case for more widespread use of NAC in urothelial BCa

Palavras Chave

Bladder Cancer; Radical Cystectomy; Neoadjuvant chemotherapy; Complications