You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease II1 Apr 20101703 A COMPARISON OF PERIOPERATIVE COMPLICATIONS IN BLADDER CANCER PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY OR RADICAL CYSTECTOMY, ALONE Cheryl Lee, James Montie, Maha Hussain, David Smith, David Wood, Alon Weizer, and Stephanie Daignault Cheryl LeeCheryl Lee More articles by this author , James MontieJames Montie More articles by this author , Maha HussainMaha Hussain More articles by this author , David SmithDavid Smith More articles by this author , David WoodDavid Wood More articles by this author , Alon WeizerAlon Weizer More articles by this author , and Stephanie DaignaultStephanie Daignault More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1550AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) has a proven survival advantage in patients with muscle invasive bladder cancer. However <2% of urologists utilize NAC to treat locally advanced tumors. Concerns about perioperative complications exist. This study evaluates patterns of complications in patients treated with RC with or without NAC. METHODS A 2:1 treatment:control study design compared patients with cT2-4 bladder cancer treated with RC or NAC and RC from 1990-2007. Patients were matched on age, gender, and RC year. The NAC regimen was platin-based in 94% of cases. Complications were assessed within 30 days after RC. Complications experienced prior to RC were excluded. An elder subset, aged ≥75 years, was evaluated using the same matching criteria. To account for the treatment:control design, odds of complication were estimated using generalized estimating equation logistic models. RESULTS The population included 124 cases and 197 controls. There was no difference in age, gender, ASA, BMI, tobacco use, performance status, operative time, blood loss, urinary diversion, or hospital or intensive care unit (ICU) stay between groups. Clinical and pathologic staging revealed higher stage tumors in the NAC group (p<.0001). The NAC group also had a higher rate of blood transfusion after RC (p=.049). Complications were seen in 36% of patients receiving NAC and 43% of those with RC, alone (p=.29). In multivariate analyses, patients ≥75 years receiving NAC (n=24), were 3 times more likely to suffer a complication than those treated with RC, alone (n=42) [OR 3.0 (95% CI: 1.2,7.5) p=.038]; however, elder patients did not have a higher risk of severe complications [OR 1.66 (95% CI: 0.50,5.49) p=.44]. CONCLUSIONS Neoadjuvant chemotherapy is a safe strategy for middle-aged patients undergoing RC; however, this treatment strategy has a much higher risk of perioperative complication in elder patients. Providers should consider this increased complication risk in patients over 75 years of age when planning treatment strategies and counsel individual patients appropriately. Ann Arbor, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e657-e658 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheryl Lee More articles by this author James Montie More articles by this author Maha Hussain More articles by this author David Smith More articles by this author David Wood More articles by this author Alon Weizer More articles by this author Stephanie Daignault More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...