title: Neoadjuvant chemotherapy for bladder cancer does not increase risk of perioperative morbidity.
abstract: OBJECTIVE
  To determine whether neoadjuvant chemotherapy (NAC) is a predictor of postoperative complications, length of stay (LOS), or operating time after radical cystectomy (RC) for bladder cancer.
  
  
  METHODS
  A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed to identify patients receiving NAC before RC from 2005 to 2011. Bivariable and multivariable analyses were used to determine whether NAC was associated with 30-day perioperative outcomes, e.g. complications, LOS, and operating time.
  
  
  RESULTS
  Of the 878 patients who underwent RC for bladder cancer in our study, 78 (8.9%) received NAC. Excluding those patients who were ineligible for NAC due to renal insufficiency, 78/642 (12.1%) received NAC. In all, 457 of the 878 patients (52.1%) undergoing RC had at least one complication ≤30 days of RC, including 43 of 78 patients (55.1%) who received NAC and 414 of 800 patients (51.8%) who did not (P = 0.58). On multivariable logistic regression, NAC was not a predictor of complications (P = 0.87), re-operation (P = 0.16), wound infection (P = 0.32), or wound dehiscence (P = 0.32). Using multiple linear regression, NAC was not a predictor of increased operating time (P = 0.24), and patients undergoing NAC had a decreased LOS (P = 0.02).
  
  
  CONCLUSIONS
  Our study is the first large multi-institutional analysis specifically comparing complications after RC with and without NAC. Using a nationally validated, prospectively maintained database specifically designed to measure perioperative outcomes, we found no increase in perioperative complications or surgical morbidity with NAC. Considering these findings and the well-established overall survival benefit over surgery alone, efforts are needed to improve the uptake of NAC.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Johnson
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Matthews
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D061646:Operative Time; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents
keywords: cystectomy; neoadjuvant therapy; neoplasms; outcomes assessment; urinary bladder