Contemporary radical cystectomy outcomes in patients with invasive bladder cancer: a population‐based study

Abstract

ObjectiveTo determine the contemporary survival outcomes from a whole population and identify significant predictors of survival, as contemporary population-based survival outcomes after radical cystectomy (RC) for the treatment of bladder cancer (BC) are sparse. Reports suggest a large disparity between population outcomes and those of centres of excellence. Patients and Methods ResultsOf 804 patients diagnosed during the study period 420 (52.2%) died during follow-up. The 5-year DSS and OS for all patients was 59.6% and 53.2%, respectively. The 5-year DSS for patients with localised, regional and distant disease, undergoing RC was 72%, 51% and 10%, respectively. Age (P < 0.001) and stage (P < 0.001) were associated with 5-year DSS and OS after adjusting for all other variables. High-volume centres had significantly better 5-year DSS compared with low-volume centres (P < 0.05). The 30-day mortality for high-vs low-volume centres was 1.8% and 3.6%, respectively. Perioperative mortality improved over time for high-and moderate-volume centres but not for low-volume centres. ConclusionContemporary survival outcomes after RC are much improved compared with older studies and appear close to results from academic centres of excellence. High-volume centres report better 5-year DSS outcomes than lower volume centres.

Hospital volume and perioperative outcomes for radical cystectomy: a population study

“…Additionally, we were unable to record post-hospital events including readmission, complications and longer-term mortality from the dataset. This issue was also encountered by Patel et al [8] who used an advanced probabilistic linkage technique. Finally, there is no accepted definition of the minimum caseload required to be classified as high volume.…”

“…This issue was also encountered by Patel et al. who used an advanced probabilistic linkage technique. Finally, there is no accepted definition of the minimum caseload required to be classified as high volume.…”

“…Patel et al. recently reported data from New South Wales, another Australian region. Whilst not statistically significant, a lower risk of 30‐day (1.8% vs 4.3%) and 90‐day (3.6% vs 6.4%) mortality was reported for HVH compared to LVH.…”

Variations in Preoperative Use of Bone Scan Among Medicare Beneficiaries Undergoing Radical Cystectomy

“…1 Although radical cystectomy can be curative, a modest proportion of patients will die from metastases present at the time of diagnosis. 2–5 To minimize unnecessary surgery in these patients, current guidelines recommend preoperative imaging of the chest, abdomen, and pelvis, most commonly with a chest radiograph and computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen and pelvis. 1, 6 …”

Is robotic radical cystectomy ready for prime time?

“…The introduction of RARC to hospitals in Australia and New Zealand is associated with a number of important considerations. First, RC in low volume centres in NSW is associated with higher perioperative mortality and disease‐specific mortality . Introduction of this highly complex surgical procedure should be limited to high volume hospitals.…”