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Short-term Complications after Cystectomy in Patients treated with Neoadjuvant Chemotherapy is only associated with Comorbidity
Sarah P Psutka, Adam S Feldman, Richard J Lee, Aria F Olumi
Massachusetts General Hospital, Boston, MA

Introduction: We wished to evaluate the complication rates after cystectomy in patients who received neoadjuvant chemotherapy for treatment of muscle-invasive urothelial carcinoma (MI-UC). Methods: We evaluated patients with MI-UC who received neoadjuvant chemotherapy cisplatin and gemcitabine between January 2003 and February 2011 (n=32). Patients were excluded if they also received neoadjuvant radiation therapy (n= 15). Any complication within 90 days of surgery was graded using the Clavien-Dindo system. Results: Median patient age was 70 years with a median American Society of Anesthesiologists (ASA) score of 3. Patients received a median of 3 cycles of chemotherapy a median of 119 days prior to RC. Ileal conduits were performed in all except for 3 cases, in which orthotopic neobladders were performed. Pelvic lymphadenectomy was aborted in 2 cases due to extensive fibrosis. Median operative time was 9.5 hours with median EBL of 900cc. 25 complications were identified in 10 patients (59%). Complications were classified as grade 1 in 6% (1), grade 2 in 41% (7), grade 3 in 12% (2) and grade 4 in 6% (1). Increased risk of complication was associated with ASA Score ≥ 3 (p=0.03), whereas number of cycles of neoadjuvant GC, duration between CG and RC, type of urinary diversion, BMI, or preoperative hydronephrosis did not (P>0.05). Conclusions: The early complication rates in patients treated with neoadjuvant CG before cystectomy is associated with ASA score, while the number of cycles of chemotherapy, type of urinary diversion or interval between chemotherapy and RC do not affect morbidity.


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