Radical Cystectomy in England from 2013 to 2019 on 12,644 patients: An analysis of national trends and comparison of surgical approaches using Hospital Episode Statistics data

Abstract

Introduction We evaluate the data of 12,644 Radical Cystectomies in England (Open, Robotic and Laparoscopic) with trends in the adaption of techniques and post‐operative complications. Methods This analysis utilised national Hospital Episode Statistics (HES) from NHS England. Results There was a statistically significant increase (P < .001) in the number of Robotic assisted radical cystectomies from 10.8% in 2013‐2014 and 39.5% in 2018‐2019.The average LOS reduced from 12.3 to 10.8 days for RARC from 2013 to 2019 similarly the LOS reduced from 16.2 to 14.3 for ORC. The rate of sepsis (0‐90 days) did rise from 5% to 14.5% between 2013‐2014 and 2017‐2018 for the entire cohort (P < .001). Acute renal failure (ARF) increased over the years from 9.5% to 17% (P < .001). The rate for fever, UTI, critical care activity and ARF were higher for ORC than RARC (P < .001).The comparison of all episodes within 90 days for conduit versus non‐conduit diversions showed significantly higher rates of sepsis, infections, UTI and fever in non‐conduit group .Overall complications were significantly higher in non‐conduit group throughout the duration except was year 2016‐17(P < .001).The robotic approach has increased in last 5 years with nearly 40% of the cystectomies now being robotically in 2018‐19 from the initial percentage of 10.8% in 2013‐14. Conclusion This evaluation of the HES data from NHS England for 12,644 RC confirms an increase in the adoption of Robotic Cystectomy. Our data confirms the need to develop strategies with enhanced recovery protocols and post‐operative close monitoring following Radical Cystectomy in order to reduce post‐operative complications.

Open vs robot‐assisted radical cystectomy (BORARC): a double‐blinded, randomised feasibility study

“…Nevertheless, it remains questionable if a blinded phase III trial comparing ORC and iRARC will ever be performed. Real-world data suggest that the use of RARC is steadily increasing and may open up for surgery in elderly patients who may benefit more from minimally invasive surgery compared to younger patients [29].…”

Urethral Surveillance after Radical Cystectomy

“…Reasons for this may include the increased use of NACT, better stratification of high-risk NMIBC whereby RC is advocated for some patient risk groups that perhaps had previously been managed with intravesical therapies (BCG failure and HR-NMIBC progression are associated with worse outcomes than MIBC), 5,12,13 and the increasing age and comorbidity with which patients are being offered RC (reduced lifespan over which to find URs). 1 Although our study data cannot…”

“…Approximately 2100 radical cystectomies (RCs) are performed each year in England with curative intent, for primary or recurrent non-muscle-invasive (NMIBC), or muscle-invasive bladder cancers (MIBC). 1 Following RC, local tumour recurrence within the residual urethra, often proximally where the epithelial lining still comprises urothelial cells, is a rare but well-described occurrence. 2 Urethral recurrences (URs) are widely considered as heralds of poor prognosis, and have been reported as associated with significantly increased risks of local invasion, metastatic disease, and increased disease-specific mortality (55-75% within 28 months of detection).…”

Chasing the elusive goal

“…The overall failure rate was 8% with several of the failures coming from radiation fibrosis indications. The figures and tables are highly useful with a surgical atlas on key steps of the procedure, cohort descriptions, complications, and a flow chart illustrating the clinical failures. To the drawing board… For our academic section, Tamhankar et al 4 looked at the trends in radical cystectomy in England and used a specific database from the National Health Service in England. Our literature has ample health services research data using United States‐based data systems, so it is refreshing to see a different source.…”

“…To the drawing board… For our academic section, Tamhankar et al 4 looked at the trends in radical cystectomy in England and used a specific database from the National Health Service in England. Our literature has ample health services research data using United States‐based data systems, so it is refreshing to see a different source.…”