Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: A high-volume tertiary cancer center experience Journal Article
| Authors: | Donat, S. M.; Shabsigh, A.; Savage, C.; Cronin, A. M.; Bochner, B. H.; Dalbagni, G.; Herr, H. W.; Milowsky, M. I. |
| Article Title: | Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: A high-volume tertiary cancer center experience |
| Abstract: | Background: Perioperative cisplatin combination chemotherapy is associated with a survival benefit in patients with invasive bladder cancer (BCa). However, in a recent report from the National Cancer Database (NCDB), only 11.6% of stage III BCa patients received perioperative chemotherapy, the majority in the adjuvant setting. Objective: We explore the impact of postoperative complications on the timing of adjuvant chemotherapy. Design, setting, and participants: An independent review board approved the review of 1142 consecutive radical cystectomies (RC), and data from these cases were entered into a prospective complication database (1995-2005) which was utilized and retrospectively reviewed for accuracy at a single, academic, tertiary cancer center. Interventions: All patients underwent RC/urinary diversion by high-volume, fellowship-trained, urologic oncologists. Measurements: All complications within 90 d of surgery were defined and graded using a five-grade modification of the original Clavien system utilized at Memorial Sloan-Kettering Cancer Center and stratified into 11 categories. Grade 2-5 complications typically prohibit starting adjuvant chemotherapy. Univariate and multivariable logistic regression were used to evaluate variables associated with complications. Results and limitations: Overall, 64% (735 of 1142 patients) experienced one or more complications, of which 83% (611 of 735) were grade 2-5. Furthermore, 57% of grade 2-5 complications (347 of 611) occurred between discharge and 90 d, 38% (233 of 611) within 6 wk, and 19% (114 of 611) between 6 wk and 12 wk, the general time frame for adjuvant chemotherapy. Overall, 26% (298 of 1142 patients) required readmission. Surgical morbidity at a high-volume tertiary cancer center may not reflect the case mix or surgical experience seen in the community setting. Conclusion: This series demonstrates that 30% of patients (347 of 1142) undergoing RC may not have been able to receive adjuvant chemotherapy due to postoperative complications. This information should be taken into consideration when planning multimodal therapy and further supports the use of perioperative chemotherapy in the neoadjuvant setting. © 2008 European Association of Urology. |
| Keywords: | cancer chemotherapy; treatment outcome; cancer surgery; major clinical study; mortality; cisplatin; adjuvant therapy; cancer adjuvant therapy; multiple cycle treatment; gastrointestinal symptom; morbidity; bladder cancer; postoperative complication; postoperative complications; cancer center; cardiovascular disease; thromboembolism; adjuvant chemotherapy; radical cystectomy; cystectomy; reoperation; postoperative infection; hospital readmission; postoperative hemorrhage; bladder surgery; logistic regression analysis; neurological complication; urogenital tract disease; wound infection |
| Journal Title: | European Urology |
| Volume: | 55 |
| Issue: | 1 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2009-01-01 |
| Start Page: | 177 |
| End Page: | 186 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2008.07.018 |
| PROVIDER: | scopus |
| PUBMED: | 18640770 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 16" - "Export Date: 30 November 2010" - "CODEN: EUURA" - "Source: Scopus" |
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