No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study.

Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking.

We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not.

Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82-1.39) or mortality (OR 0.75 95% CI 0.36-1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30-0.81).

This nation-wide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.

World journal of urology. 2019 Apr 24 [Epub ahead of print]

Tomas Jerlström, Ruoqing Chen, Fredrik Liedberg, Ove Andrén, Viveka Ströck, Firas A S Aljabery, Abolfazl Hosseini, Amir Sherif, Per-Uno Malmström, Anders Ullén, Truls Gårdmark, Katja Fall

Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden. ., Department of Urology, Skåne University Hospital, Malmö, Sweden., Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden., Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden., Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden., Department of Urology, Institute of Surgical Sciences, Uppsala, Sweden., PO Bäckencancer, Theme Cancer, Karolinska University Hospital and Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden., Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden., Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.