Impact of neoadjuvant chemotherapy on short-term complications and survival following radical cystectomy

  • Uros Milenkovic
  • Murat Akand
  • Lisa Moris
  • Liesbeth Demaegd
  • Tim Muilwijk
  • Youri Bekhuis
  • Annouschka Laenen
  • Ben Van Cleynenbreugel
  • Wouter Everaerts
  • Hein Van Poppel
  • Herlinde Dumez
  • Maarten Albersen
  • Steven JoniauEmail author
Original Article



To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS).

Materials and methods

Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien–Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1–2 and high-grade (HGC) CDC 3–5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan–Meier analysis.


A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all).


In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.


Radical cystectomy Bladder cancer Neoadjuvant chemotherapy Complications Short term 



Bladder cancer


Non-muscle-invasive bladder cancer


Muscle-invasive bladder cancer


Radical cystectomy


Pelvic lymph node dissection


Urinary diversion


Neoadjuvant chemotherapy


Overall survival


Bacillus Calmette–Guérin


Carcinoma in situ


Charlson comorbidity index


Age-adjusted Charlson comorbidity index


Body mass index




Estimated blood loss


Length of stay


Clavien–Dindo Classification


High-grade complication


Low-grade complication


Cancer-specific survival


Standard deviation


Interquartile range


Cumulative incidence function


Inverse probability of treatment weighting


Odds ratio


Confidence interval


Hazard ratio


Other-cause survival


Urinary tract infection







Akand M is supported by a clinical scholarship from the European Urologic Scholarship Program (EUSP).Joniau S is a senior clinical researcher of the research foundation of Flanders (FWO).

Authors’ contributions

UM: Data collection, data analysis, manuscript writing. MA: Data analysis, manuscript writing, manuscript editing. LM: Data collection, data analysis. LD: Data collection, data analysis. TM: Data analysis, manuscript editing. YB: Data collection, data analysis. AL: Data analysis, manuscript editing. BVC: Data collection, data analysis. WE: Data collection, data analysis. HVP: Project development, data analysis, manuscript editing. HD: Project development, data analysis, manuscript editing. MA: Project development, data analysis, manuscript editing. SJ: Project development, data analysis, manuscript editing.


None declared.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to this manuscript.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Uros Milenkovic
    • 1
    • 2
  • Murat Akand
    • 1
    • 3
  • Lisa Moris
    • 1
  • Liesbeth Demaegd
    • 1
  • Tim Muilwijk
    • 1
  • Youri Bekhuis
    • 1
  • Annouschka Laenen
    • 1
  • Ben Van Cleynenbreugel
    • 1
  • Wouter Everaerts
    • 1
    • 2
  • Hein Van Poppel
    • 1
  • Herlinde Dumez
    • 4
  • Maarten Albersen
    • 1
    • 2
  • Steven Joniau
    • 1
    Email author
  1. 1.Department of UrologyUniversity Hospitals LeuvenLouvainBelgium
  2. 2.Laboratory of Experimental Urology, Department of Development and RegenerationCatholic University of LeuvenLouvainBelgium
  3. 3.School of Medicine, Department of UrologySelcuk UniversityKonyaTurkey
  4. 4.University Hospitals Leuven, Department of General Medical Oncology, Leuven Cancer InstituteKU LeuvenLouvainBelgium

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