Impact of neoadjuvant chemotherapy on the peri-operative morbidity of radical cystectomy for muscle invasive bladder cancer

Introduction. - Platinum-based neoadjvant chemotherapy (NAC) before radical cystectomy (RC) is the gold standard in the treatment of muscle invasive bladder cancer (MIBC). We aimed to compare the peri-operative morbidity in patients treated by NAC then RC and patients having RC alone. Methods. - Between 1st January 2008 and 31st December 2015, we retrospectively included consecutive patients undergoing RC for MIBC in 2 centers. We collected clinical, pathological and peri-operative data (30 day post operative complications according to the Clavien-Dindo score, delayed complications, pathological results). Patients treated by NAC (NAC-RC group) before RC were compared to patients performing RC alone. The NAC-RC group received 1 to 6 cycle of high-dose MVAC, MVAC or gemcitabine-cisplatine chemotherapy. Logistic regression identified independant factors of peri-operative complications. Results. - We included 199 patients: 48 in the NAC-RC group and 151 in the RC group. Complications rate was 73.9% in the NAC-RC group versus 73.8% in the RC group (P=1.0). In multivariate analyses, only the Charlson score was associated with an increased risk of peri-operative complications (P=0.05). PTO tumour rate was significantly higher in the NAC-CR group (50% vs 7%, P<0.001). Conclusion. - NAC does not increase the peri-operative morbidity of the RC. Patients' pre-operative comorbidities is the main risk factor for peri-operative complications. (C) 2018 Elsevier Masson SAS. All rights reserved.