Population-based analyses of radical cystectomy and urinary diversion for bladder cancer in northern Italy

Abstract

Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Published population‐based data related to recourse to cystectomy, adoption of partial instead of radical cystectomy, determinants of perioperative mortality, complications and length of stay, pelvic lymphadenectomy, and type of urinary diversion, have been largely investigated in the USA, whereas evidence from Western and Southern Europe is lacking. This first population‐based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion, and a decreasing trend of length of stay and in‐hospital mortality. OBJECTIVE • To provide updated figures on urinary diversion, length of stay and mortality after cystectomy in two regions of northern Italy. PATIENTS AND METHODS • Discharge records of patients undergoing cystectomy for bladder cancer in 2000–2008 were extracted from the regional archives of hospital discharges. • Data on partial vs radical cystectomy and type of urinary diversion were obtained from intervention codes. • The influence of demographic characteristics, year of intervention, presence of comorbidities and hospital cystectomy volume on the adoption of a continent diversion and on in‐hospital mortality was assessed through multilevel models. RESULTS • The crude cystectomy rate was close to 10 per 100 000. • The share of partial cystectomies declined from 5.5% in 2000–2002 to 3.0% in 2006–2008. • A continent diversion was adopted in 35% of radical cystectomies, with higher rates in young male patients treated in high‐volume hospitals. • Median length of stay declined from 20 days in 2000–2002 to 18 in 2006–2008; in‐hospital mortality decreased from 3.2% to 2.2%. CONCLUSION • This first population‐based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion and a decreasing trend of length of stay and in‐hospital mortality.

The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology

“…Hospital stay in our cohort (median 14 days) may seem long to an American reader, as most studies from the USA report a median stay between 5 and 8 days [4,22]. Nonetheless, our LOSs are in line with other European centers [30], and the multiple social and cultural differences existing across our continents are probably accountable for the longer hospital stay we herein report. Of note, our patients are discharged only when all drains and catheters have been removed.…”

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

“…Our hospital-volume classifications were based on the different caseloads performed in the specific Victorian population. In other studies as shown in Table 5 [4,17,18,26,27,[39][40][41][42][43], there is marked variation in the minimum volume threshold for HVH (ranging from 2.75 to 63.5 per year). Analysis of different thresholds has not identified a particular hospital volume associated with a greater volume-outcome relationship [16].…”

Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample

“…For cystectomy patients, ICD-9 codes were used to categorize the urinary diversion as an ileal conduit (56.51, 56.71), a continent diversion (57.87), ureterostomy (56.61), or unknown. 16 …”