Aims: Radical cystectomy (RC) is a relatively uncommon surgical procedure and the management of patients undergoing this surgery is complex. We conducted a review of bladder cancer patients who underwent a radical cystectomy to understand patterns of surgery and outcomes in Queensland.
Methods: This review includes patients diagnosed with bladder cancer who underwent radical cystectomy from 2002-2016. Data was obtained from the Queensland Oncology Repository (QOR). A review of pathology reports was conducted. Hospitals were categorised as high (>7 RCs/year) and low (≤7 RCs/year). Multivariate analysis and 2-year overall survival was conducted. Follow-up time was to 31 December 2018.
Results: In the fifteen-year period 7403 patients were diagnosed with bladder cancer, of these 1230 underwent radical cystectomy. Overall 77% were male and the median age was 67 years. One third (33.5%) were T-stage 3 & 4 at diagnosis. Of the cohort, 71% of (n = 871) had a lymph node dissection and the median number of nodes removed was 7 (range 1–73). Positivity rate was 22.8% and this was similar across hospital volumes. Patients residing in middle and disadvantaged areas were less likely to have had lymph node dissection (OR=0.46, 95% CI 0.28–0.75 and OR=0.44, 95% CI 0.23–0.84). Lymph node dissection was more likely for public compared to private patients (OR=2.69, 95% CI 2.10–3.44). Surgical margins were involved in 9.7% of patients. Surgical margin involvement was higher in low-volume hospitals (10.9% versus 7.1%, respectively, P = 0.03). Stage (P < 0.001), positive lymph nodes (P ≤ 0.001), no lymph node dissection (P = 0.003), involvement of surgical margins (P <0.001) were all significantly associated with poorer overall survival.
Conclusions: This review has identified some sub-groups of patients experience poorer post-operative outcomes. Later stage, positive lymph nodes, no lymph node dissection and surgical margin involvement were all predictors of poorer survival.