Background: Although the survival benefit of neoadjuvant chemotherapy (NAC) in bladder cancer patients receiving radical cystectomy (RC) has been established, the NAC associated complication rate is not well-known, especially in elderly patients. Methods: We identified 427 patients who had undergone RC for clinical TanyN0M0 bladder cancer from 2005 to 2015 at our 7 institutions. Among them, 118 (27.6%) were treated with gemcitabine and cisplatin (GC)-NAC. The details of the complication rate during and after RC were recorded according to the Clavien-Dindo classification. We evaluated the association between the complication rate for RC with NAC and patient age. Results: Overall, 60 (14.0%), 306 (71.7%), and 61 (14.3%) patients were < 60, 60-79, and ≥ 80 years old, respectively. Overall, 190 (44.5%) patients had some kind of postoperative complication and there was no difference in the postoperative complication rate between the NAC and non-NAC groups (37.3% vs 47.2%: p = 0.065). However, the incidence rate of post-operative ileus in the NAC group was 9.3%, which was significantly lower than that in the non-NAC group (19.1%, p = 0.013). Sixteen (26.7%), 93 (30.4%) and 9 (14.8%) patients in the < 60, 60-79, and ≥ 80 age groups, respectively, received GC-NAC. Among patients < 60 years old, the complication rates for post-operative ileus, pyelonephritis and wound infection were 12.5%, 18.8%, and 0% in the NAC group, which were not significantly different from those in the non-NAC group (9.1%, 6.8%, and 13.6%, respectively). Among 60-79 year-old patients, the corresponding complication rates were 8.6%, 11.8%, and 9.7% in the NAC group, which were not significantly different from those in the non-NAC group (17.8%, 9.9%, and 9.4%, respectively). Among patients ≥ 80 years old, the rates were 11.1%, 11.1%, and 33.3% in the NAC group, which were not significantly different from those in the non-NAC group (28.8%, 11.5%, and 13.5%, respectively). Furthermore, in patients treated with GC-NAC, no association was observed in the complication rates among patients < 60 years, 60-79 years, and ≥ 80 years old. Conclusions: NAC could be provided safely at the time of RC regardless of patient age.