MP65-05 DETERMINING THE OPTIMAL TIMING FOR RADICAL CYSTECTOMY AFTER NEOADJUVANT CHEMOTHERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-05 DETERMINING THE OPTIMAL TIMING FOR RADICAL CYSTECTOMY AFTER NEOADJUVANT CHEMOTHERAPY Chinedu Mmeje, Cooper Benson, Graciela Nogueras-Gonzalez, Isuru Jayaratna, Neema Navai, Jianjun Gao, Arlene Siefker-Radtke, Ashish Kamat, Colin Dinney, and Jay Shah Chinedu MmejeChinedu Mmeje More articles by this author , Cooper BensonCooper Benson More articles by this author , Graciela Nogueras-GonzalezGraciela Nogueras-Gonzalez More articles by this author , Isuru JayaratnaIsuru Jayaratna More articles by this author , Neema NavaiNeema Navai More articles by this author , Jianjun GaoJianjun Gao More articles by this author , Arlene Siefker-RadtkeArlene Siefker-Radtke More articles by this author , Ashish KamatAshish Kamat More articles by this author , Colin DinneyColin Dinney More articles by this author , and Jay ShahJay Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present the largest series reviewing complications and pathologic outcomes following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), to determine whether the interval between chemotherapy and surgery (ICS) affects 90-day post-operative morbidity and lymph node metastasis. METHODS We analyzed 338 patients treated with NAC followed by RC from January 1995 through December 2013. The association of ICS with 90-day surgical morbidity, incidence of major complication, 90-day readmission, and lymph node metastasis was determined. Generalized linear models were used to determine potential predictors of each endpoint. Patients were stratified into four groups by ICS days (18 - 42;43 - 64;64 - 85;> 85). Complications were classified using the Clavien system. RESULTS The overall morbidity of the cohort was 59%, with 66% being minor, and 34% being major complications. The median ICS was 46 days (18 - 199 days). There was no difference in the overall morbidity, readmission, or major complication rates among the four groups. Patients with an ICT > 85 days had the highest incidence of lymph node metastasis (40%), though this was not found to be significant (p = 0.1). On multivariate analysis including predictors of perioperative morbidity, extravesical (pT3 - 4) disease (OR = 1.97; p = 0.01) was an independent predictor of overall morbidity, while age at cystectomy (OR = 1.05; p = 0.004), and surgical time ≥ 7 hrs (OR = 2.87; p = 0.001) were independent predictors of major complications. Only surgical time ≥ 7 hrs (OR = 2.24; p = 0.006) was found to be a predictor of readmission. In a separate multivariate analysis that included risk factors for pathological node positivity, the predictors for lymph node metastasis included variant histology (OR = 2.06; p = 0.026) and extravesical disease (OR = 2.76; p = 0.002). Patients with an ICT > 85 days had a higher risk of node metastasis though this was not significant. CONCLUSIONS Patients can undergo RC anytime between 2.5 - 12 weeks after NAC with no difference in risk of surgical complications or nodal metastasis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e808-e809 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chinedu Mmeje More articles by this author Cooper Benson More articles by this author Graciela Nogueras-Gonzalez More articles by this author Isuru Jayaratna More articles by this author Neema Navai More articles by this author Jianjun Gao More articles by this author Arlene Siefker-Radtke More articles by this author Ashish Kamat More articles by this author Colin Dinney More articles by this author Jay Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...