Neoadjuvant Chemotherapy Is Not Associated with Adverse Perioperative Outcomes after Robot-Assisted Radical Cystectomy: A Case for Increased Utilization from the IRCC.

We sought to determine the trend of neoadjuvant chemotherapy use for nonmetastatic muscle invasive urothelial bladder cancer and whether it is associated with adverse perioperative morbidity after robot-assisted radical cystectomy.

We retrospectively reviewed the IRCC (International Robotic Cystectomy Consortium) database between 2006 and 2017. After excluding patients with nonmuscle invasive bladder cancer the patients were divided into 2 groups, including those who did vs did not receive neoadjuvant chemotherapy. Data were reviewed for demographics, preoperative, operative and 90-day perioperative outcomes. We used the Cochran-Armitage trend test to assess trends of neoadjuvant chemotherapy associations with high grade and overall complications with time. Multivariate stepwise regression analyses were done to determine whether neoadjuvant chemotherapy was associated with prolonged operative time, 90-day postoperative complications, readmissions, reoperations and mortality after robot-assisted radical cystectomy.

A total of 298 patients (26%) received neoadjuvant chemotherapy. These patients were younger (age 67 vs 69 years, p=0.01) and more frequently had an ASA (American Society of Anesthesiologists™) score of 3 or greater (62% vs 55%, p=0.02) and pathological T3 stage or greater disease (28% vs 22%, p=0.04). The use of neoadjuvant chemotherapy increased significantly from 10% in 2006 to 2007 to 42% in 2016 to 2017 (p <0.01). On multivariate analysis neoadjuvant chemotherapy was not significantly associated with prolonged operative time, hospital stay, 90-day postoperative complications, reoperation or mortality. Neoadjuvant chemotherapy was associated with 90-day readmissions after robot-assisted radical cystectomy (OR 5.90, 95% CI 3.30-10.90, p <0.01).

Neoadjuvant chemotherapy utilization has significantly increased in the last decade. It was not associated with perioperative surgical morbidity after robot-assisted radical cystectomy.

The Journal of urology. 2019 Jul 17 [Epub ahead of print]

Naif A Aldhaam, Ahmed S Elsayed, Zhe Jing, Lee Richstone, Andrew A Wagner, Koon Ho Rha, Bertram Yuh, Juan Palou, Muhammad Shamim Khan, Mani Menon, Morgan Roupret, Derya Balbay, Abolfazl Hosseini, Peter Wiklund, Franco Gaboardi, Thomas J Maatman, Alexandre Mottrie, Carl Wijburg, Michael Stöckle, Ashok Hemal, Eric Kim, Jihad Kaouk, Ahmed A Hussein, Khurshid A Guru

Roswell Park Comprehensive Cancer Center, Buffalo, New York., Arthur Smith Institute for Urology, New Hyde Park, New York., Beth Israel Deaconess Medical Center, Boston, Massachusetts., Yonsei Medical Health Care System, Seoul, South Korea., City of Hope National Cancer Center, Duarte, California., Fundació Puigvert, Barcelona, Spain., Guy's Hospital, London, United Kingdom., Henry Ford Health System, Detroit, Michigan., Hôpital Pitié-Salpétrière, Paris, France., Koç University Hospital, Istanbul, Turkey., Karolinska Institute, Solna, Sweden., Luigi Sacco (San Raffaele), Milan, Italy., Metro Health Hospital, Wyoming, Michigan., Orsi Academy/Onze-Lieve-Vrouwziekenhuis, Aalst, Flanders., Rijnstate Hospital, Arnhem, The Netherlands., Universitätsklinikum des Saarlandes, Homburg, Germany., Wake Forest Medical Center, Winston-Salem, North Carolina., Washington University, St. Louis, Missouri., Cleveland Clinic, Cleveland, Ohio.