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Neoadjuvant Chemotherapy is Not Associated with Adverse Perioperative Outcomes after Robot-Assisted Radical Cystectomy: A Case for Increased Use from the IRCC

 Naif A Aldhaam  ;  Ahmed S Elsayed  ;  Zhe Jing  ;  Lee Richstone  ;  Andrew A Wagner  ;  Koon Ho Rha  ;  Bertram Yuh  ;  Juan Palou  ;  Muhammad Shamim Khan  ;  Mani Menon  ;  Morgan Roupret  ;  Derya Balbay  ;  Abolfazl Hosseini  ;  Peter Wiklund  ;  Franco Gaboardi  ;  Thomas J Maatman  ;  Alexandre Mottrie  ;  Carl Wijburg  ;  Michael Stöckle  ;  Ashok Hemal  ;  Eric Kim  ;  Jihad Kaouk  ;  Ahmed A Hussein  ;  Khurshid A Guru 
 JOURNAL OF UROLOGY, Vol.203(1) : 57-61, 2020-01 
Journal Title
Issue Date
Aged ; Antineoplastic Agents / therapeutic use ; Chemotherapy, Adjuvant* ; Cystectomy* ; Humans ; Male ; Neoadjuvant Therapy* ; Operative Time ; Patient Readmission / statistics & numerical data ; Postoperative Complications ; Reoperation / statistics & numerical data ; Retrospective Studies ; Robotic Surgical Procedures* ; Survival Rate ; Urinary Bladder Neoplasms / drug therapy* ; Urinary Bladder Neoplasms / mortality ; Urinary Bladder Neoplasms / pathology ; Urinary Bladder Neoplasms / surgery*
cystectomy ; morbidity ; mortality ; robotic surgical procedures ; urinary bladder
Purpose: We sought to determine the trend of neoadjuvant chemotherapy use for nonmetastatic muscle invasive urothelial bladder cancer and whether it is associated with adverse perioperative morbidity after robot-assisted radical cystectomy.

Materials and methods: We retrospectively reviewed the IRCC (International Robotic Cystectomy Consortium) database between 2006 and 2017. After excluding patients with nonmuscle invasive bladder cancer the patients were divided into 2 groups, including those who did vs did not receive neoadjuvant chemotherapy. Data were reviewed for demographics, preoperative, operative and 90-day perioperative outcomes. We used the Cochran-Armitage trend test to assess trends of neoadjuvant chemotherapy associations with high grade and overall complications with time. Multivariate stepwise regression analyses were done to determine whether neoadjuvant chemotherapy was associated with prolonged operative time, 90-day postoperative complications, readmissions, reoperations and mortality after robot-assisted radical cystectomy.

Results: A total of 298 patients (26%) received neoadjuvant chemotherapy. These patients were younger (age 67 vs 69 years, p=0.01) and more frequently had an ASA™ (American Society of Anesthesiologists™) score of 3 or greater (62% vs 55%, p=0.02) and pathological T3 stage or greater disease (28% vs 22%, p=0.04). The use of neoadjuvant chemotherapy increased significantly from 10% in 2006 to 2007 to 42% in 2016 to 2017 (p <0.01). On multivariate analysis neoadjuvant chemotherapy was not significantly associated with prolonged operative time, hospital stay, 90-day postoperative complications, reoperation or mortality. Neoadjuvant chemotherapy was associated with 90-day readmissions after robot-assisted radical cystectomy (OR 5.90, 95% CI 3.30-10.90, p <0.01).

Conclusions: Neoadjuvant chemotherapy utilization has significantly increased in the last decade. It was not associated with perioperative surgical morbidity after robot-assisted radical cystectomy.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
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