No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study

Research output: Contribution to journalArticle

Abstract

Purpose: Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking. Methods: We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not. Results: Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82–1.39) or mortality (OR 0.75 95% CI 0.36–1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30–0.81). Conclusion: This nation-wide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.

Details

Authors
  • Tomas Jerlström
  • Ruoqing Chen
  • Fredrik Liedberg
  • Ove Andrén
  • Viveka Ströck
  • Firas A.S. Aljabery
  • Abolfazl Hosseini
  • Amir Sherif
  • Per Uno Malmström
  • Anders Ullén
  • Truls Gårdmark
  • Katja Fall
Organisations
External organisations
  • Örebro University
  • Karolinska Institutet
  • Sahlgrenska University Hospital
  • Linköping University
  • Umeå University
  • Uppsala University
  • Karolinska University Hospital
  • Danderyd Hospital
  • Skåne University Hospital
  • University of Gothenburg
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery
  • Cancer and Oncology
  • Urology and Nephrology

Keywords

  • Bladder cancer, Induction chemotherapy, Neoadjuvant chemotherapy, Postoperative complications, Radical cystectomy
Original languageEnglish
Pages (from-to)381-388
Number of pages8
JournalWorld Journal of Urology
Volume38
Issue number2
Early online date2019 Apr 24
Publication statusPublished - 2020 Feb
Publication categoryResearch
Peer-reviewedYes