title: Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume tertiary cancer center experience.
abstract: BACKGROUND
  Perioperative cisplatin combination chemotherapy is associated with a survival benefit in patients with invasive bladder cancer (BCa). However, in a recent report from the National Cancer Database (NCDB), only 11.6% of stage III BCa patients received perioperative chemotherapy, the majority in the adjuvant setting.
  
  
  OBJECTIVE
  We explore the impact of postoperative complications on the timing of adjuvant chemotherapy.
  
  
  METHODS
  An independent review board approved the review of 1142 consecutive radical cystectomies (RC), and data from these cases were entered into a prospective complication database (1995-2005) which was utilized and retrospectively reviewed for accuracy at a single, academic, tertiary cancer center.
  
  
  METHODS
  All patients underwent RC/urinary diversion by high-volume, fellowship-trained, urologic oncologists.
  
  
  METHODS
  All complications within 90 d of surgery were defined and graded using a five-grade modification of the original Clavien system utilized at Memorial Sloan-Kettering Cancer Center and stratified into 11 categories. Grade 2-5 complications typically prohibit starting adjuvant chemotherapy. Univariate and multivariable logistic regression were used to evaluate variables associated with complications.
  
  
  CONCLUSIONS
  Overall, 64% (735 of 1142 patients) experienced one or more complications, of which 83% (611 of 735) were grade 2-5. Furthermore, 57% of grade 2-5 complications (347 of 611) occurred between discharge and 90 d, 38% (233 of 611) within 6 wk, and 19% (114 of 611) between 6 wk and 12 wk, the general time frame for adjuvant chemotherapy. Overall, 26% (298 of 1142 patients) required readmission. Surgical morbidity at a high-volume tertiary cancer center may not reflect the case mix or surgical experience seen in the community setting.
  
  
  CONCLUSIONS
  This series demonstrates that 30% of patients (347 of 1142) undergoing RC may not have been able to receive adjuvant chemotherapy due to postoperative complications. This information should be taken into consideration when planning multimodal therapy and further supports the use of perioperative chemotherapy in the neoadjuvant setting.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, United States. donats@mskcc.org
authors.forename: S Machele
authors.initials: SM
authors.lastname: Donat
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shabsigh
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*