High Grade Complication Rates Seen With Post-Robotic Radical Cystectomy

Patients with muscle-invasive bladder cancer (MIBC) who underwent robotic-assisted radical cystectomy after immunotherapy-based neoadjuvant treatment have more higher-grade postoperative complication rates compared to patients undergoing robotic radical cystectomy (RARC) alone, according to study findings presented during the SUO 25^th Annual Meeting.

The analysis included 136 patients who received an immunotherapy-based regimen from 2017-2023. Reuben Ben-David, MD, of the Icahn School of Medicine, Mount Sinai Hospital, New York, New York, and colleagues evaluated the 30- and 90-day complication rates of patients who underwent RARC and used Clavien-Dindo classification to describe grades of complications.

Neoadjuvant regimens that use immunotherapy and combination immunotherapy/chemotherapy are being explored in patients with MIBC, the researchers explained. “Although RARC has decreased the morbidity associated with the surgery, the overall morbidity remains high,” they remarked.

Patients who participated in this study were mostly men (n=114) with a median age of 66 years. The median body mass index was 25, and 44.9% of patients were former smokers. More than 80% of patients received extracorporeal robotic surgery. Immune checkpoint inhibitor monotherapy was given to 84 patients, while 52 patients received combination immunochemotherapy.

The study results determined that the overall 30-day grade ≥3a Clavien-Dindo complication rate was 27.2% and 16.2% after 30-90 days. In addition, the most common complications were infectious (44.9%) and gastrointestinal (21.3%). A small percentage of patients experienced pulmonary, cardiovascular, genitourinary, thromboembolic, neurologic, and hemorrhagic complications.

Patients spent a median of 11 days in the hospital, and the researchers found no differences in complications between those who received immunotherapy alone or combination therapy. More than a quarter of patients (26.5%) were readmitted to the hospital after 30 days.

Grade 2 immune-related adverse events (irAEs) were reported in five patients (3.6%). The irAEs included dermatitis (n=2), hypothyroidism (n=1), colitis (n=1), and pneumonitis (n=1).

“Postoperative grade ≥3a complication rates after novel neoadjuvant treatment with immunotherapy agents appear higher than previously reported for patients undergoing RARC alone,” the researchers said.

Although irAEs are rare, the researchers discussed the importance of understanding the side effects of immunotherapy agents specifically for clinicians.

Reference

Ben-David R, Pellegrino F, Thomas J, et al. Complication rates of patients undergoing robotic-assisted radical cystectomy following neoadjuvant immunotherapy and combination immunochemotherapy. Poster #37. Presented at the 25th Annual Meeting of the Society of Urologic Oncology; December 4-6, 2024; Dallas, Texas.