The Impact of Gender on Tumour Stage in In-House Complications and Choice of Urinary Diversion: Results of the Austrian Cystectomy Registry

Abstract

Introduction and Objectives: Bladder cancer is characterized by gender-dependent disparities. To further address this issue, we analysed a prospective, multicentre cystectomy registry. Methods: An online database was developed that included patient demographics, intra/perioperative data, surgical data and in-house complications. Results: Four hundred fifty-eight patients (112 [24.5%] women and 346 [75.5%] men) were analysed. Men and women were comparable regarding age (mean 68 years), body mass index (mean 26.5) and the mean Charlson score (4.8). Women had more advanced tumour-stages (pT3/pT4; women: 57.1%; men: 48.1%). The rate of incontinent urinary diversion was higher in women (83.1%) than in men (60.2%) and in a multivariate analysis, the strongest predictors were M+ status (OR 11.2), female gender (OR 6.9) and age (OR 6.5). Women had a higher intraoperative blood transfusion rate. The overall rate of in-house complications was similar in both genders (men: 32.0%, women: 32.6%). Severe (Clavien-Dindo grade >2) medical (women: 6.3%; men: 5.2%) and surgical (women: 21.5%; men: 14.4%) in-house complications, however, were more frequent in women. Conclusions: This multicentre registry demonstrates several gender-related differences in patients undergoing radical cystectomy. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women.

Gender and Mortality after Radical Cystectomy: Competing Risk Analysis

“…A somewhat greater age difference between males and females (1 year [3] vs. 3.1 years in this study) and a less favorable stage distribution in females are further demographic differences between the current and the cited study [3]. A similar difference between females and males concerning the presence of extravesical disease (T3-4, 58.7 vs. 47.2% [8]) as in the current study was observed in a recent multicenter study from Austria [7], whereas in a Canadian multicenter study that observed narrowly identical mortality rates lower differences (T3-4 in females 61 vs. 58% in males [6]) were found. In one multicenter study, a lower 90-day mortality rate was observed in females [9], a finding that was not confirmed in our study (Table 1).…”

Health-Related Quality of Life after Radical Cystectomy for Bladder Cancer in Elderly Patients with Ileal Orthotopic Neobladder or Ileal Conduit: Results from a Multicentre Cross-Sectional Study Using Validated Questionnaires

“…The Austrian Cystectomy Registry demonstrated several gender-related differences in patients undergoing RC. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women [17]. …”

Sex differences in treatment patterns for non-advanced muscle-invasive bladder cancer: a descriptive analysis of 3484 patients of the Netherlands Cancer Registry

“…Some single-center analyses have reported that women undergoing RC have longer operative time, more blood loss, and more frequent perioperative complications and a higher 90-day mortality risk. In addition, the rates of pelvic lymph node dissection and continent diversion are lower for women [ 17 , 18 ]. In a recent analysis of a large US RC cohort, female sex was associated with longer operative time and length of stay, while reoperation, readmission and 30-day mortality rates were similar [ 19 ].…”