1597 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON ANEMIA AND PERIOPERATIVE OUTCOMES AT THE TIME OF CYSTECTOMY

Introduction and Objective: While Neoadjuvant chemotherapy (NC) prior to cystectomy has demonstrated a survival advantage in patients with T2-4aN0MO urothelial carcinoma, the impact of NC on anemia and perioperative outcomes is not well defined. Here we evaluate the impact of NC on preoperative anemia, need for blood transfusions in the perioperative period and postoperative complications at the time of cystectomy. Methods: A single intuition retrospective review from 2005 to 2009 for patients undergoing radical cystectomy for T2-4aN0M0 urothelial carcinoma was performed. Patients receiving NC were matched 2:1 with patients not receiving NC (controls) for age, gender, and BMI. Comparisons of patient co-morbidity (Charlson score), hemoglobin (Hgb) prior to cystectomy, need for transfusions, estimated blood loss, postoperative complications, and severity of complications (Clavien grade) were made. Statistical comparisons were performed with Kruskal-Wallis Test and ChiSquare Tests as appropriate. Results Obtained: 20 patients receiving NC were matched with 40 patients not receiving NC (controls). Patients receiving NC and controls did not differ significantly in age, BMI, Charlson co-morbidity score, operative time or estimated blood loss during surgery. Baseline Hgb (prior to NC) was similar between groups. Preoperative Hgb (following NC) was significantly lower in NC patients (11.7 g/dL) compared to controls (13.6 g/dL), p = 0.0014. Patients receiving NC (70%) were more likely to receive a blood transfusion during surgery compared to controls (38%), p = 0.17. Additionally, the number of units of blood transfused was significantly greater in NC patients (3.2 units) compared to controls (1.4 units), p = 0.004. Postoperative transfusion requirements, days until oral intake, length of hospital stay, postoperative complication rates, severity of postoperative complications were similar between groups. Conclusions: NC was not associated with an increased rate of postoperative complications. However, NC was associated with a lower preoperative Hgb and an increased need for blood transfusion during cystectomy. Despite increased blood transfusion requirements associated with NC, we continue to advocate the use of NC in appropriate candidates given the survival advantage noted in randomized trials. Objective Define the impact of neoadjuvant chemotherapy for bladder cancer peri-operative outcomes specifically involving: 1.Pre-operative anemia 2.Blood transfusions 3.Post-operative complications Methods • Retrospective review from 2005-2009 • Radical Cystectomy •cT2-4aN0M0 • NC patients matched 2:1 for age, gender, BMI • Compared: •Charlson score •Pre-operative Hgb •Transfusion need and amount •EBL •Postoperative complications •Severity of complications Conclusions • NC not associated with increased rate of post-operative complications • NC associated with lower preoperative Hgb and increased need for blood transfusion during cystectomy • Continue to advocate use of NC in proper candidates due to survival advantage Figure 1: Anemia and Need for Transfusion in Patients Undergoing Radical Cystectomy Figure 2: Time to Oral Intake and Length of Stay Table 1. Demographics of Patients Undergoing Radical Cystectomy Neoadjuvant Chemotherapy Controls P value Gender (%male) 85% 85% Age Mean 62 Median 60 Range 46-81 Mean 62 Median 61 Range 50-78 0.82 BMI Mean 28 Median 27 Range 19.5-39.1 Mean 29 Median 29 Range 20.3-50.2 0.33 Average ASA Score 2.86 2.47 0.065 Average Charlson Score 3.1 2.7 0.099 Table 2. Operative Variables and Pathology Neoadjuvant Chemotherapy Controls P value EBL (ml) Mean 1511 Median 1600 Range 400-3000 Mean 1201 Median 1000 Range 300-5000 0.20 Operative Time (min) Mean 364 Median 326 Range 174-448 Mean 340 Median 335 Range 180-665 0.88 Pathology T stage T0 Tis T1 T2 T3 T4 N stage Nx N0 N1 N2 0 6 2 7 2 3 4 12 1 2 2 6 5 12 12 3