Impact of neoadjuvant chemotherapy on short-term complications following robotic radical cystectomy

Abstract

Purpose: To evaluate the effect of neoadjuvant chemotherapy (NAC) on short-term complications following robotic radical cystectomy (RRC). Methods: A retrospective review of 134 bladder cancer patients who underwent RRC. Perioperative outcomes were compared between patients who received NAC (nRRC) and those who underwent upfront RRC (uRRC). Primary outcome: 30-day Clavien-Dindo classification score of ⩾2 (CDC ⩾ 2). Secondary outcomes: 30-day infectious complications, readmission rates, postoperative ileus, blood transfusion, and mortality. Results: Of the 134 patients, 90 (67%) were in the nRRC group and 44 (33%) in the uRRC group. The total 30-day CDC ⩾ 2 complication rates and high-grade complications were comparable between the groups. Among the various outcomes assessed, only postoperative ileus showed a statistically significant difference, with lower rates in the nRRC (20% vs 38.4%, OR = 0.39, p = 0.021). Other outcomes, including 30-day readmission, infectious complications and blood transfusions, were similar. All four cases of 30-day mortality occurred in the nRRC group. Conclusion: NAC in the era of RRC was not associated with a statistically significant increase in overall perioperative complication rates in our cohort. NAC can likely be administered without a significant increase in perioperative complications, although confirmation in larger studies is warranted.