Improved surgical outcomes following radical cystectomy at high-volume centers influence overall survival

Scarberry, Kyle; Berger, Nicholas G.; Scarberry, Kelly; Agrawal, Shree; Francis, John J.; Yih, J.; Gonzalez, Christopher; Abouassaly, Robert

doi:10.1016/j.urolonc.2018.03.007

Cited by 36 publications

(36 citation statements)

References 24 publications

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“…We found the proportion of patients undergoing lymph node dissection increased significantly over time. The number of patients with a positive surgical margin in our study (10%) is also in line with others . We found no association with either 2‐year or 5‐year survival and hospital volume.…”

Section: Discussionsupporting

confidence: 93%

“…We found later stage (III–IV), positive lymph node(s), no lymph node dissection and surgical margin involvement were all predictors of poorer survival. These findings are in keeping with a large study of 39 000 patients in the USA . In our study, 71% of patients had a lymph node dissection, similar to an English study where approximately 74% of patients received a lymph node dissection .…”

Section: Discussionsupporting

confidence: 92%

“…In this study 72% and 56% of patients were alive at 2 and 5 years, respectively, which compares favourably with other studies . We observed a survival advantage for patients treated more recently.…”

Section: Discussionsupporting

confidence: 86%

“…We found no association with either 2‐year or 5‐year survival and hospital volume. While some studies have reported improved survival outcomes for patients treated at high‐volume centres, results have, however, been inconsistent . This inconsistency likely reflects differing methodological approaches (such as lack of adjustment for casemix and in‐hospital clustering) as well as heterogeneity of hospital (and surgeon) volumes.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Coughlin

Youl

Philpot

et al. 2019

ANZ Journal of Surgery

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Background: Radical cystectomy (RC) is a complex uro-oncology surgical procedure with high surgical morbidity. We report on outcomes following RC for bladder cancer using a population-based cohort of patients. Methods: Patients receiving an RC from 2002 to 2016 were included and linked to their cancer-related surgical procedures. Hospitals were categorized as high (>7 RCs/year) and low (≤7 RCs/year). Outcomes included 30-and 90-day mortalities and 2-year overall survival (OS). Multivariable logistic regression models were used to examine factors associated with the outcomes of interest. OS was estimated using the Kaplan-Meier survival function. Results: During the 15-year study period, 1230 patients underwent an RC for invasive bladder cancer. In-hospital mortality was 1.1%, and 30-and 90-day mortality was 1.4% and 2.9%, respectively. Both 30-and 90-day mortalities were significantly higher for older versus younger patients (P = 0.01 and P < 0.001, respectively), and lymph node involvement was significantly associated with 90-day mortality (P = 0.002). Patients treated more recently were about 80% less likely to die within 90 days. The 2-year OS was 71.5%, with significant improvements observed over time (P < 0.001). While we found no evidence of a hospital-volume relationship for post-operative mortality or survival, patients treated in lowvolume compared to high-volume hospitals were more likely to have surgical margin involvement (10.9% versus 7.1%, respectively, P = 0.03). Conclusion: We observed low post-operative mortality rates overall, with rates decreasing significantly over time. Some subgroups of patients experience poorer post-operative outcomes. Reporting on post-operative outcomes, and survival over time helps monitor clinical progress and identify areas for improvement.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Coughlin

Youl

Philpot

et al. 2019

ANZ Journal of Surgery

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“…Two studies from the USA show an association between increased hospital volumes and improved long‐term OS, after adjustment for comorbidity and tumour stage . One of those investigations included only patients with CCI 0 or 1, in order to reduce unmeasured confounding .…”

Section: Discussionmentioning

confidence: 99%

Period‐specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population‐based study

et al. 2019

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Systematic review of the association between socioeconomic status and bladder cancer survival with hospital type, comorbidities, and treatment delay as mediators

et al. 2021

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Improved surgical outcomes following radical cystectomy at high-volume centers influence overall survival

Cited by 36 publications

References 24 publications

Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Period‐specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population‐based study

Systematic review of the association between socioeconomic status and bladder cancer survival with hospital type, comorbidities, and treatment delay as mediators

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