title: Perioperative complications of radical cystectomy after induction chemoradiotherapy in bladder-sparing protocol against muscle-invasive bladder cancer: a single institutional retrospective comparative study with primary radical cystectomy.
abstract: OBJECTIVE
  To compare rates of early morbidity after radical cystectomy in patients treated with or without induction chemoradiotherapy (CRT) using a standardized reporting methodology.
  
  
  METHODS
  All 193 consecutive patients undergoing radical cystectomy for bladder cancer between 1989 and 2010 were retrospectively reviewed. Induction chemoradiotherapy consists of radiation at 40 Gy to the small pelvis and two cycles of concurrent cisplatin at 20 mg/day for 5 days. Deaths within 90 days after radical cystectomy and complications arising within 30 days were recorded and graded according to the Clavien-Dindo classification. Grades 1-2 were considered minor; Grades 3-5 were considered major.
  
  
  RESULTS
  Eighty-seven patients underwent radical cystectomy following chemoradiotherapy (chemoradiotherapy group) while the remaining 106 primarily underwent radical cystectomy (no chemoradiotherapy group). No Grade 4-5 complication was observed. Overall, 118 patients (61%) experienced 36 major and 122 minor complications. There was no significant difference in the incidence of overall complications between the chemoradiotherapy and no chemoradiotherapy groups (67 vs. 57%). Overall urinary anastomosis-related complications and major gastrointestinal complications, most of which were Grade 3 ileus, were more frequent in the chemoradiotherapy group than the no chemoradiotherapy group (11 vs. 2%, P = 0.007; and 14 vs. 4%, P = 0.02; respectively). Multivariate analysis identified induction chemoradiotherapy as an independent risk factor for overall urinary anastomosis-related complications (relative risk 6.0, P = 0.01) but not for major gastrointestinal complications.
  
  
  CONCLUSIONS
  Induction chemoradiotherapy at 40 Gy in bladder-sparing protocols against MIBC is unlikely to increase the rate of severe complications of radical cystectomy.
authors: Department of Urology, Tokyo Medical and Dental University Graduate School, Yushima, Tokyo 113-8519, Japan.
authors: Aki
authors: A
authors: Iwai
authors: Fumitaka
authors: F
authors: Koga
authors: Yasuhisa
authors: Y
authors: Fujii
authors: Hitoshi
authors: H
authors: Masuda
authors: Kazutaka
authors: K
authors: Saito
authors: Noboru
authors: N
authors: Numao
authors: Mizuaki
authors: M
authors: Sakura
authors: Satoru
authors: S
authors: Kawakami
authors: Kazunori
authors: K
authors: Kihara
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects*; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual / Q000601:surgery; D059351:Organ Sparing Treatments / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016879:Salvage Therapy; D001749:Urinary Bladder Neoplasms / Q000601:surgery / Q000628:therapy*