Effects of Neoadjuvant Chemotherapy Treatment on Perioperative Outcomes Following Radical Cystectomy

Objective: This study aimed to assess the impact of neoadjuvant chemotherapy (NAC) on perioperative outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma. Materials and Methods: We retrospectively analyzed the clinical records of 317 patients who underwent RC and ileal loop diversion between February 2019 and May 2025. Patients were categorized into NAC+RC and RC-only groups. Demographic, preoperative, intraoperative, and postoperative variables were evaluated. Propensity score matching (PSM) was conducted to match the groups in a 1:1 ratio using the nearest-neighbor matching algorithm in terms of age, body mass index (BMI), previous surgery history, American Society of Anesthesiologists (ASA) score, preoperative T stage, hemoglobin, white blood cell (WBC), incision length and urinary diversion technique. Results: Among the 317 patients, 60 (18.9%) received NAC+RC and 257 (81.1%) underwent RC alone. Preoperative T2 stage was more prevalent in the NAC group compared with the RConly group (85% vs. 68.5%, p=0.024). Preoperative hemoglobin (12.6 vs. 11.9 g/dL, p=0.006) and white blood cell levels (8886.9 vs. 7416.8/μL, p<0.001) were significantly higher in the RConly group. Postoperative complications were more frequent among RC-only patients (47.5% vs. 31.7%, p=0.027). After PSM, 57 matched pairs were obtained. The RC-only group demonstrated higher blood transfusion requirements (1 vs. 0 units, p = 0.048), longer hospitalization (17 vs. 15 days, p=0.015), and delayed return to oral intake (3 vs. 3 days, p=0.028) compared with the matched NAC+RC group. Although complications were more common in the RC-only group, the difference was not statistically significant (29% vs. 19%, p=0.058). Conclusion: NAC does not adversely affect perioperative morbidity following RC and may enhance specific postoperative recovery parameters. These findings support the safety and clinical value of NAC in appropriately selected patients with muscle-invasive bladder cancer. Keywords: complication, neoadjuvant chemotherapy, radical cystectomy, treatment