title: Complications of radical cystectomy: impact of the timing of perioperative chemotherapy.
abstract: OBJECTIVE
  To evaluate the impact of timing of perioperative chemotherapy on morbidity of radical cystectomy in patients with bladder cancer.
  
  
  METHODS
  We compared the complications in patients randomized to neoadjuvant (n = 53) or adjuvant (n = 49) MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy.
  
  
  RESULTS
  In the 95 patients who underwent cystectomy, there were no significant differences in treatment compliance, surgical parameters, or postoperative recovery between the two groups. In patients who received neoadjuvant chemotherapy, there were more complications, and there was one perioperative death; however, these differences were not significant. The neoadjuvant group took longer to complete therapy (P < 0.001). Nine patients (3 neoadjuvant, 6 adjuvant) did not undergo cystectomy on time.
  
  
  CONCLUSIONS
  Cystectomy following neoadjuvant MVAC chemotherapy is feasible. We were unable to demonstrate any difference between neoadjuvant and adjuvant chemotherapy in mortality, morbidity, or postoperative clinical course.
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Hall
authors.forename: D A
authors.initials: DA
authors.lastname: Swanson
authors.forename: C P
authors.initials: CP
authors.lastname: Dinney
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010349:Patient Compliance; D011182:Postoperative Care; D011300:Preoperative Care; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014747:Vinblastine / Q000627:therapeutic use
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate