MP67-07 NEOADJUVANT CHEMOTHERAPY (NAC) HAS NO ADVERSE EFFECT ON RADICAL CYSTECTOMY (RC) OR PERIOPERATIVE COMPLICATIONS.

Abstract

muscle invasive bladder cancer. Midline fascial defects including wound dehiscence and incisional hernia are morbid postoperative events. Our objective was to identify predisposing factors for midline fascial defects in this population with multiple morbidities. METHODS: The records of all patients who underwent cystectomy and ileal conduit between 1994 and 2011 were reviewed. Wound dehiscence was defined as a midline separation of the fascia requiring operative reclosure. Post-operative incisional hernia was defined as a palpable fascial defect on follow-up physical exam. Univariate and multivariate logistic regression models of factors that may be predictive of midline fascial defect were conducted. RESULTS: A total of 963 patients were identified with a median age of 71 years and median follow-up of 15.8 months (range, 0.23 e 188.85 months). Ninety-four patients (9.8%) developed a midline fascial defect (51 wound dehiscences, 43 incisional hernias). A multivariate logistic regression model for midline fascial defects demonstrated that steroid usage and post-operative wound infections were independent predictors. Fewer than expected wound events occurred in patients who received neoadjuvant chemotherapy. In the wound dehiscence subgroup, post-operative wound infection was the only significant factor (p1⁄4<0.0001, OR1⁄412.69, 6.15-25.51). Patient age, body mass index, prior abdominal surgery, nutritional factors and post-op pneumonia were not independently predictive of either midline fascial defect or wound dehiscence. The neoadjuvant group had significantly lower albumin, pre-op hemoglobin (Hgb), and Total Lymphocyte Count (TLC) levels in comparison to the non-neoadjuvant group. CONCLUSIONS: In our cohort of 963 of ileal conduit patients, post-operative wound infection is the most important predictor of the devastating complications of wound dehiscence and midline fascial defects. Patients who received neoadjuvant chemotherapy had fewer than expected wound complications despite having lower pre-op albumin, Hgb and TLC.