Centralization and prospective audit of cystectomy are necessary: a commentary on the case for centralization, supported by a contemporary series utilizing the ANZUP cystectomy database

Abstract

Bladder cancer (BC) outcomes are unacceptably poor. In Australia, BC survival is actually deteriorating. There is an urgent need to improve outcomes in BC patients, which requires a multipronged approach. One area deserving closer scrutiny is radical cystectomy. Audit is necessary to identify areas for improvement and without it, outcomes remain unknown. Evidence convincingly shows high‐volume surgeons and centers improve cystectomy outcomes including overall survival, yet centralization has still not occurred. The Australia and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group cystectomy database has been established to facilitate cystectomy audit in Australia and New Zealand. We present initial data from the ANZUP cystectomy database from a single high‐volume center, discuss the benefits of centralization and its challenges in the Asia‐Pacific context.

Comparing fluorodeoxyglucose positron emission tomography with computed tomography in staging for nodal and distant metastasis in urothelial/bladder cancer

“…Fifty-four patients (72%) had histopathology available from pelvic lymph node dissection or biopsy. Following initial staging scans with CT and FDG-PET scans, 87% (47/54) of patients underwent radical cystectomy and pelvic lymph node dissection (Table 1) with a median node count of 17 (0-52 nodes), 12 and 13% (7/54) had radiologically guided biopsy for histological confirmation of lesions suspicious for metastasis (Table 2).…”

“…Fifty‐four patients (72%) had histopathology available from pelvic lymph node dissection or biopsy. Following initial staging scans with CT and FDG‐PET scans, 87% (47/54) of patients underwent radical cystectomy and pelvic lymph node dissection (Table 1 ) with a median node count of 17 (0–52 nodes), 12 and 13% (7/54) had radiologically guided biopsy for histological confirmation of lesions suspicious for metastasis (Table 2 ). The remaining 21 patients who had histologically confirmed muscle‐invasive urothelial carcinoma from endoscopic resection with radiological evidence of metastatic disease on CT or PET scans were deemed not to require histological confirmation of metastasis as per the consensus of the uro‐oncology multidisciplinary meeting.…”

Lymph node assessment technique matters in radical cystectomy for bladder cancer

“…This routinely included lymph node tissue from the obturator fossa as well as the common, external, and internal iliac regions, but did not routinely involve nodal tissue medial to the ureter crossing of the common iliac artery, or pre‐sacral lymph nodes. Further details and outcomes from this series have been reported 17 …”

“…Further details and outcomes from this series have been reported. 17 Patients were separated into two groups based on whether they underwent cystectomy before or after the change in pathological processing technique of examining nodal specimens. Statistical analysis was performed using SPSS (version 26; IBM Corporation).…”