Introduction:

Neoadjuvant regimens that involve the use of immunotherapy and combination of immunotherapy with chemotherapy are being explored for patients with  muscle-invasive bladder cancer prior to radical cystectomy. Although, robotic radical cystectomy (RARC) has decreased the morbidity associated with the surgery, the overall morbidity remains high. We seek to assess the 30-and 90 days complication rates of patients undergoing RARC among patients that received neoadjuvant regimens consisting of immunotherapy and combination of immunotherapy with chemotherapy.

Methods:

A bi-center analysis of patients who underwent RARC and received a immunotherapy-based neoadjuvant regimen during 2017-2023. Clavien-Dindo classification was used to describe grades of complication.

Results:

The cohort included 136 patients with a median age of  66 (IQR 61-73), 22 were females (16.2%). The overall 30-days and 30-90 days grade ≥3a Clavien-Dindo complication rate was 27.2%, and 16.2% respectively (Figure 1). The most common were infectious (44.9%) and gastrointestinal (21.3%), 36 patients (26.5%) required readmission (Table 1). Eighty-four patients received monotherapy with immune checkpoint inhibitor and 52 received combination immunochemotherapy. The median hospital stay was 11 days (IQR 7-16), no differences were found between the different complications categories between immunotherapy and immunochemotherapy. Five patients (3.6%) experienced immune-related Adverse events, all were of Clavien-Dindo grade 2 (two patients had dermatitis, one had hypothyroidism, one had colitis and one had pneumonitis).   

Conclusion:

Postoperative grade ≥3a complication rates after novel neoadjuvant treatment with immunotherapy agents appear higher than previously reported for patients undergoing RARC alone. Immunotherapy-related adverse events were documented in 3.6% of the patients, although rare, urologists should be familiar with the side effect profile of immunotherapy agents. Results from clinical trials are awaited to further validate our results.

Funding: N/A